Contract Pharmacy Details

KROGER DRUGSTORE #436
DSH360134 THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO

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 DRUGSTORE #436

Pharmacy Address

5341 HWY 20, SOUTH
COVINGTON, GA 30016

Pharmacy Comments

Contract Details

Approval Date

4/13/2015

Contract Begin Date

7/1/2015

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2015
Agreement registered in error

Contacts

Covered Entity Signing Official

Michael Crofton, Sr. Vice President & CFO
(513) 569-6577

Contract Pharmacy Representative

Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672

Signed By Date

4/13/2015

340B Drug Pricing Program Database