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KROGER PHARMACY #014441
DSH360076 ATRIUM MEDICAL CENTER
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Covered Entity Details
Entity Name
ATRIUM MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360076
Entity Address
ONE MEDICAL CENTER DRIVE
MIDDLETOWN, OH 45005-1006
Medicare Provider Number
360076
Participating Start Date
10/1/2020
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
KROGER PHARMACY #014441
Pharmacy Address
3420 TOWNE BLVD
MIDDLETOWN, OH 45005
Pharmacy Comments
Contract Details
Approval Date
1/13/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/22/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Craig Allen Ganger, Chief Financial Officer
(937) 499-9988
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
1/13/2021
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