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KROGER PHARMACY 014482
DSH360134 THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO
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Covered Entity Details
Entity Name
THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360134
Entity Address
375 DIXMYTH AVE
CINCINNATI, OH 45220
Medicare Provider Number
360134
Participating Start Date
4/1/2006
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
KROGER PHARMACY 014482
Pharmacy Address
3609 WARSAW AVE
CINCINNATI, OH 45205
Pharmacy Comments
Contract Details
Approval Date
1/21/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/18/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Craig Rucker, Sr. Vice President and CFO
(513) 569-6107
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
1/21/2014
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