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KROGER PHARMACY #456
DSH440131 BAPTIST MEMORIAL HOSPITAL- TIPTON
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Covered Entity Details
Entity Name
BAPTIST MEMORIAL HOSPITAL- TIPTON
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH440131
Entity Address
1995 HIGHWAY 51 S
COVINGTON, TN 38019-2338
Medicare Provider Number
440131
Participating Start Date
9/4/2008
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
KROGER PHARMACY #456
Pharmacy Address
7615 HIGHWAY 70
BARTLETT, TN 38133
Pharmacy Comments
Contract Details
Approval Date
4/19/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kimberly Young, Vice President-Finance Operations
(901) 227-4080
Contract Pharmacy Representative
Kroger
Katie Elfers, 340B Pharmacy Administrator
(513) 762-4850
Signed By Date
4/19/2022
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