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KROGER PHARMACY #014335
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 #014335
Pharmacy Address
428 OXFORD STATE RD
MIDDLETOWN, OH 45044-7434
Pharmacy Comments
Contract Details
Approval Date
10/7/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/1/2017
Business decision by covered entity and/or pharmacy
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
10/7/2015
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