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KROGER PHARMACY 014353
DSH360003 University of Cincinnati Medical Center LLC
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Covered Entity Details
Entity Name
University of Cincinnati Medical Center LLC
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360003
Entity Address
3188 Bellevue Avenue
CINCINNATI, OH 45219
Medicare Provider Number
360003
Participating Start Date
12/1/1992
Last Recertification Date
8/18/2024
Pharmacy Details
Pharmacy Name
KROGER PHARMACY 014353
Pharmacy Address
11390 MONTGOMERY ROAD
CINCINNATI, OH 45249
Pharmacy Comments
Contract Details
Approval Date
7/13/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/15/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
RICK HINDS, Executive Vice President and Chief Financial Officer
(513) 585-8720
Contract Pharmacy Representative
Kroger Health
Eva Brumfield, Strategic Program Director
(651) 357-2109
Signed By Date
7/13/2023
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