Contract Pharmacy Details

KROGER CO
DSH420086 PRISMA HEALTH BAPTIST HOSPITAL

Covered Entity Details

Entity Name

PRISMA HEALTH BAPTIST HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH420086

Entity Address

1333 Taylor Street
COLUMBIA, SC 29202

Medicare Provider Number

420086

Participating Start Date

7/1/2006

Last Recertification Date

8/21/2024

Pharmacy Details

Pharmacy Name

KROGER CO

Pharmacy Address

DBA KROGER SAV-ON #002
7467 ST ANDREWS RD SUITE 6
IRMO, SC 29063

Pharmacy Comments

Contract Details

Approval Date

4/20/2022

Contract Begin Date

7/1/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/31/2024
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Michael Bundy, Chief Executive Officer
(803) 296-5782

Contract Pharmacy Representative

Kroger
Katie Elfers, 340B Pharmacy Administrator
(513) 762-4850

Signed By Date

4/20/2022

340B Drug Pricing Program Database