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KROGER PHARMACY L739
DSH180141 UNIVERSITY OF LOUISVILLE HOSPITAL
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Covered Entity Details
Entity Name
UNIVERSITY OF LOUISVILLE HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180141
Entity Address
530 SOUTH JACKSON STREET
LOUISVILLE, KY 40202
Medicare Provider Number
180141
Participating Start Date
7/1/1996
Last Recertification Date
8/31/2024
Pharmacy Details
Pharmacy Name
KROGER PHARMACY L739
Pharmacy Address
12450 LAGRANGE RD
LOUISVILLE, KY 40245
Pharmacy Comments
Contract Details
Approval Date
7/15/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/17/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Steve Amsler, Senior Vice President of Operations
(502) 562-4122
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
7/15/2020
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