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KROGER PHARMACY #014827
FQHCLA393B Neighborhood Health Center, INC
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Covered Entity Details
Entity Name
Neighborhood Health Center, INC
Subdivision Name
Fayette County Medical Center
Type
Health Center Program Look-Alike
340B ID
FQHCLA393B
Entity Address
2025 Virginia Avenue
Connersville, IN 47331-2971
Grant Number
LALCS32717
Participating Start Date
1/1/2023
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
KROGER PHARMACY #014827
Pharmacy Address
516 WEST 30TH STREET
CONNERSVILLE, IN 47331
Pharmacy Comments
Contract Details
Approval Date
10/4/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Carrie N Miles, CEO
(765) 965-4299
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
10/3/2022
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