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KROGER PHARMACY #014910
RRC360009-00 LIMA MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
LIMA MEMORIAL HOSPITAL
Subdivision Name
Type
Rural Referral Center
340B ID
RRC360009-00
Entity Address
1001 BELLEFONTAINE AVENUE
LIMA, OH 45804
Medicare Provider Number
360009
Participating Start Date
5/4/2020
Last Recertification Date
8/24/2023
Entity Termination Date
10/1/2024
Pharmacy Details
Pharmacy Name
KROGER PHARMACY #014910
Pharmacy Address
475 FORTMAN DRIVE
ST. MARYS, OH 45885
Pharmacy Comments
Contract Details
Approval Date
1/14/2022
Contract Begin Date
2/22/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Eric Donald Pohjala, CFO
(419) 226-5163
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
1/14/2022
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