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KROGER PHARMACY #605
RRC010039-00 HUNTSVILLE HOSPITAL
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Covered Entity Details
Entity Name
HUNTSVILLE HOSPITAL
Subdivision Name
Type
Rural Referral Center
340B ID
RRC010039-00
Entity Address
101 SIVLEY ROAD SW
HUNTSVILLE, AL 35801
Medicare Provider Number
010039
Participating Start Date
12/1/2020
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
KROGER PHARMACY #605
Pharmacy Address
4579 WALL TRIANA HWY
MADISON, AL 35758
Pharmacy Comments
Contract Details
Approval Date
11/24/2020
Contract Begin Date
12/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Clinton Carter, CFO
(256) 265-8818
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
11/24/2020
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