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KROGER PHARMACY L-868
CHC26598-00 Maury Regional Hospital
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Covered Entity Details
Entity Name
Maury Regional Hospital
Subdivision Name
Lewis Health Center
Type
HRSA-Funded Health Center
340B ID
CHC26598-00
Entity Address
617 W Main St
Hohenwald, TN 38462-1355
Grant Number
H80CS26598
Participating Start Date
10/1/2014
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
KROGER PHARMACY L-868
Pharmacy Address
1700 NORTH LOCUST ST
LAWRENCEBURG, TN 38464
Pharmacy Comments
Contract Details
Approval Date
10/28/2020
Contract Begin Date
12/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Deborah Lumpkins, Sr. VP/CNO
(931) 490-7118
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
10/28/2020
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