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KROGER PHARMACY N-512
DSH360211 TRINITY HOSPITAL HOLDING COMPANY
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Covered Entity Details
Entity Name
TRINITY HOSPITAL HOLDING COMPANY
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360211
Entity Address
4000 JOHNSON ROAD
STEUBENVILLE, OH 43952
Medicare Provider Number
360211
Participating Start Date
4/1/2022
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
KROGER PHARMACY N-512
Pharmacy Address
264 S HOLLYWOOD BLVD
STEUBENVILLE, OH 43952
Pharmacy Comments
Contract Details
Approval Date
7/18/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/17/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Dave Werkin, CFO
(740) 264-8695
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
7/18/2022
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