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Kroger Jeffersonville Central Fill (JFC) 24-0011
CAH361326-01 ADAMS COUNTY HOSPITAL DBA ADAMS COUNTY REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
ADAMS COUNTY HOSPITAL DBA ADAMS COUNTY REGIONAL MEDICAL CENTER
Subdivision Name
Family Medicine Georgetown - Family Medicine
Type
Critical Access Hospital
340B ID
CAH361326-01
Entity Address
900 Mt Orab Pike
Georgetown, OH 45121
Medicare Provider Number
361326
Outpatient Facility Provider Number
363418
Participating Start Date
10/1/2020
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
Kroger Jeffersonville Central Fill (JFC) 24-0011
Pharmacy Address
555 Race Street
Cincinnati, OH 45202
Pharmacy Comments
Contract Details
Approval Date
1/13/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/9/2023
Agreement registered in error
Contacts
Covered Entity Signing Official
Pete R Dagenbach, CFO
(937) 386-3007
Contract Pharmacy Representative
Kroger Health
Eva Brumfield, Strategic Program Director
(651) 357-2109
Signed By Date
1/13/2023
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