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KROGER PHARMACY 856
CH050960 COMMUNITY AND RURAL HEALTH SERVICES
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Covered Entity Details
Entity Name
COMMUNITY AND RURAL HEALTH SERVICES
Subdivision Name
Main Site
Type
HRSA-Funded Health Center
340B ID
CH050960
Entity Address
2221 Hayes Avenue
FREMONT, OH 43420
Grant Number
H80CS00661
Participating Start Date
7/1/1998
Last Recertification Date
2/10/2025
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
JOSEPH LISZAK, CEO
(419) 334-8943 Ext: 225
Contract Pharmacy Representative
Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672
Signed By Date
4/15/2021
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