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KROGER PHARMACY
DSH440109 HARDIN COUNTY GENERAL HOSPITAL
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Covered Entity Details
Entity Name
HARDIN COUNTY GENERAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH440109
Entity Address
935 WAYNE ROAD
SAVANNAH, TN 38372
Medicare Provider Number
440109
Participating Start Date
4/1/2006
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
KROGER PHARMACY
Pharmacy Address
775 PICKWICK ROAD
SAVANNAH, TN 38372
Pharmacy Comments
Contract Details
Approval Date
9/5/2012
Contract Begin Date
9/6/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/13/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Charlotte Burns, CEO
(731) 926-8121
Contract Pharmacy Representative
Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672
Signed By Date
8/30/2012
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