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KROGER FOOD & PHARMACY #452
RRC250141-00 BAPTIST MEM HOSPITAL DESOTO
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Covered Entity Details
Entity Name
BAPTIST MEM HOSPITAL DESOTO
Subdivision Name
Type
Rural Referral Center
340B ID
RRC250141-00
Entity Address
7601 SOUTHCREST
SOUTHAVEN, MS 38671
Medicare Provider Number
250141
Participating Start Date
11/12/2020
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
KROGER FOOD & PHARMACY #452
Pharmacy Address
7427 GOODMAN RD
OLIVE BRANCH, MS 38654
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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