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KROGER PHARMACY
DSH360068 THE TOLEDO HOSPITAL
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Covered Entity Details
Entity Name
THE TOLEDO HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360068
Entity Address
2142 N. COVE BLVD.
TOLEDO, OH 43606
Medicare Provider Number
360068
Participating Start Date
4/1/2007
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
KROGER PHARMACY
Pharmacy Address
4925 JACKMAN ROAD
TOLEDO, OH 43613
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
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
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