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KROGER PHARMACY #361
RRC450011-00 ST. JOSEPH REGIONAL HEALTH CENTER
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Covered Entity Details
Entity Name
ST. JOSEPH REGIONAL HEALTH CENTER
Subdivision Name
Type
Rural Referral Center
340B ID
RRC450011-00
Entity Address
2801 FRANCISCAN DRIVE
BRYAN, TX 77802-2544
Medicare Provider Number
450011
Participating Start Date
10/1/2018
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
KROGER PHARMACY #361
Pharmacy Address
3535 LONGMIRE DRIVE
COLLEGE STATION, TX 77845
Pharmacy Comments
Contract Details
Approval Date
10/4/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/1/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Ricardo Diaz, Chief Operating Officer
(979) 776-2580
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
10/4/2021
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