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KROGER PHARMACY #16621
CHC12886-00 LOWER LIGHTS CHRISTIAN HEALTH CENTER INC
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Covered Entity Details
Entity Name
LOWER LIGHTS CHRISTIAN HEALTH CENTER INC
Subdivision Name
Lower Lights Christian Health Center
Type
HRSA-Funded Health Center
340B ID
CHC12886-00
Entity Address
1160 W Broad St
Columbus, OH 43222-1317
Grant Number
H80CS12886
Participating Start Date
1/1/2011
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
KROGER PHARMACY #16621
Pharmacy Address
600 E MAIN ST
HEBRON, OH 43025
Pharmacy Comments
Contract Details
Approval Date
10/14/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/5/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Tracy Cloud, CEO
(614) 274-1455 Ext: 6000
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
10/14/2021
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