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KROGER PHARMACY N-529
CAH361330-02 HOCKING VALLEY COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
HOCKING VALLEY COMMUNITY HOSPITAL
Subdivision Name
HVCH OP CIC BLDG - General Surgery Physician Clinic
Type
Critical Access Hospital
340B ID
CAH361330-02
Entity Address
541 State Route 664 N
Logan, OH 43138
Medicare Provider Number
361330
Outpatient Facility Provider Number
Participating Start Date
7/1/2020
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
KROGER PHARMACY N-529
Pharmacy Address
965 POPLAR STREET
NELSONVILLE, OH 45764
Pharmacy Comments
Contract Details
Approval Date
4/11/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Julie E Grow, CFO
(740) 380-8389
Contract Pharmacy Representative
Kroger
Katie Elfers, 340B Pharmacy Administrator
(513) 762-4850
Signed By Date
4/11/2022
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