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KROGER
DSH180064 SAINT JOSEPH HEALTH SYSTEM, INC. DBA SAINT JOSEPH MOUNT STERLING
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Covered Entity Details
Entity Name
SAINT JOSEPH HEALTH SYSTEM, INC. DBA SAINT JOSEPH MOUNT STERLING
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180064
Entity Address
225 Falcon Drive
MT. STERLING, KY 40353
Medicare Provider Number
180064
Participating Start Date
12/1/2005
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
KROGER
Pharmacy Address
810 INDIAN MOUND DRIVE
MT STERLING, KY 40353
Pharmacy Comments
Contract Details
Approval Date
12/5/2012
Contract Begin Date
12/5/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/31/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Benny Nolen, President
(859) 497-5018
Contract Pharmacy Representative
Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672
Signed By Date
10/15/2012
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