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KROGER PHARMACY #16664
FQHCLA396 SHAWNEE MENTAL HEALTH CENTER INC
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Covered Entity Details
Entity Name
SHAWNEE MENTAL HEALTH CENTER INC
Subdivision Name
Portsmouth Clinic
Type
Health Center Program Look-Alike
340B ID
FQHCLA396
Entity Address
901 Washington St
Portsmouth, OH 45662-3944
Grant Number
LALCS32583
Participating Start Date
10/1/2019
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
KROGER PHARMACY #16664
Pharmacy Address
9101 OHIO RIVER ROAD
WHEELERSBURG, OH 45694
Pharmacy Comments
Contract Details
Approval Date
10/18/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Cynthia Holstein, CEO
(740) 442-7670
Contract Pharmacy Representative
Kroger Health
Eva Brumfield, Strategic Program Director
(651) 357-2109
Signed By Date
10/18/2022
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