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KROGER FOOD & PHARMACY #452
DSH440048 BAPTIST MEM HOSPITAL MEMPHIS
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Covered Entity Details
Entity Name
BAPTIST MEM HOSPITAL MEMPHIS
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH440048
Entity Address
6019 WALNUT GROVE ROAD
MEMPHIS, TN 38120
Medicare Provider Number
440048
Participating Start Date
7/1/2017
Last Recertification Date
8/26/2024
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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