340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
KROGER PHARMACY
DSH360156 MEMORIAL HOSPITAL
Print
Covered Entity Details
Entity Name
MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360156
Entity Address
715 SOUTH TAFT AVENUE
FREMONT, OH 43420
Medicare Provider Number
360156
Participating Start Date
3/15/2022
Last Recertification Date
8/28/2023
Entity Termination Date
7/1/2024
Pharmacy Details
Pharmacy Name
KROGER PHARMACY
Pharmacy Address
KROGER PHARMACY #01600536
1700 CEDAR ST
FREMONT, OH 43420-1114
Pharmacy Comments
Contract Details
Approval Date
4/15/2021
Contract Begin Date
3/15/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
David Brewer, Administrative Director - Metro Acute Care Finance
(567) 585-0257
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
4/15/2021
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