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KROGER FOOD & PHARMACY
CAH251308-00 PONTOTOC HEALTH SERVICES
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Covered Entity Details
Entity Name
PONTOTOC HEALTH SERVICES
Subdivision Name
PONTOTOC HEALTH SERVICES
Type
Critical Access Hospital
340B ID
CAH251308-00
Entity Address
176 SOUTH MAIN
PONTOTOC, MS 38863
Medicare Provider Number
251308
Participating Start Date
1/1/2015
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
KROGER FOOD & PHARMACY
Pharmacy Address
960 WEST MAIN STREET
TUPELO, MS 38801
Pharmacy Comments
Contract Details
Approval Date
7/15/2020
Contract Begin Date
7/28/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
BRUCE J. TOPPIN, GENERAL COUNSEL, PRIVACY OFFICER & COPORATE SECRETARY
(662) 377-4229
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
7/15/2020
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