Contract Pharmacy Details

KROGER PHARMACY #811
DSH360360 SOIN MEDICAL CENTER

Covered Entity Details

Entity Name

SOIN MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH360360

Entity Address

3535 PENTAGON PARK BOULEVARD
BEAVERCREEK, OH 45431

Medicare Provider Number

360360

Participating Start Date

10/1/2019

Last Recertification Date

9/7/2020

Entity Termination Date

4/1/2021

Pharmacy Details

Pharmacy Name

KROGER PHARMACY #811

Pharmacy Address

3165 DAYTON-XENIA ROAD
BEAVERCREEK, OH 45434

Pharmacy Comments

Contract Details

Approval Date

10/15/2020

Contract Begin Date

1/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2021
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Wendi Barber, Chief Financial Officer
(937) 395-8520

Contract Pharmacy Representative

Kettering Health Network:Grandview/Kettering/Ft Hamilton/Sycamore/Soin
Linda McCall, Pharmacy Director
(937) 458-4946

Signed By Date

10/15/2020

340B Drug Pricing Program Database