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KROGER FOOD & PHARMACY #427
DSH250100 BAPTIST MEMORIAL HOSPITAL-GOLDEN TRIANGLE
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Covered Entity Details
Entity Name
BAPTIST MEMORIAL HOSPITAL-GOLDEN TRIANGLE
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH250100
Entity Address
2520 5TH STREET N
COLUMBUS, MS 39705-2008
Medicare Provider Number
250100
Participating Start Date
9/2/2008
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
KROGER FOOD & PHARMACY #427
Pharmacy Address
1829 HWY 45 NORTH
COLUMBUS, MS 39701
Pharmacy Comments
01/03/2012 update Zip (was 39705)
Contract Details
Approval Date
4/19/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/21/2025
Business decision by covered entity and/or pharmacy
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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