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KROGER PHARMACY 856
CAH361318-00 Fostoria Community Hospital
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Covered Entity Details
Entity Name
Fostoria Community Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH361318-00
Entity Address
501 Van Buren Street
Fostoria, OH 44830
Medicare Provider Number
361318
Participating Start Date
7/1/2013
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
KROGER PHARMACY 856
Pharmacy Address
126 W. HIGH STREET
FOSTORIA, OH 44830
Pharmacy Comments
Contract Details
Approval Date
4/15/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ken Swint, CFO
(419) 436-6648
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
4/15/2021
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