340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
KROGER SPECIALTY PHARMACY INC
DSH050353 PROVIDENCE HEALTH SYSTEM SOUTHERN CALIFORNIA DBA PROVIDENCE LITTLE COMPANY OF MARY MEDICAL CENTER TORRANCE
Print
Covered Entity Details
Entity Name
PROVIDENCE HEALTH SYSTEM SOUTHERN CALIFORNIA DBA PROVIDENCE LITTLE COMPANY OF MARY MEDICAL CENTER TORRANCE
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050353
Entity Address
4101 TORRANCE BLVD.
TORRANCE, CA 90503
Medicare Provider Number
050353
Participating Start Date
4/1/2007
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
KROGER SPECIALTY PHARMACY INC
Pharmacy Address
KROGER SPECIALTY PHARMACY CA 3
1821 KAISER AVE
IRVINE, CA 92614-5707
Pharmacy Comments
Contract Details
Approval Date
1/13/2021
Contract Begin Date
1/21/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/18/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
John Fleming Goeders, Chief Financial Officer
(310) 829-8411
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
1/13/2021
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session