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KROGER PHARMACY #838
RRC360360-00 SOIN MEDICAL CENTER
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Covered Entity Details
Entity Name
SOIN MEDICAL CENTER
Subdivision Name
Type
Rural Referral Center
340B ID
RRC360360-00
Entity Address
3535 PENTAGON PARK BOULEVARD
BEAVERCREEK, OH 45431
Medicare Provider Number
360360
Participating Start Date
4/1/2021
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
KROGER PHARMACY #838
Pharmacy Address
1161 EAST DAYTON-YELLOWSPRINGS
ROAD
FAIRBORN, OH 45324
Pharmacy Comments
Contract Details
Approval Date
1/6/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/9/2022
Business decision by covered entity and/or pharmacy
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
1/4/2021
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