Contract Pharmacy Details

HARRIS TEETER PHARMACY #380
DSH210037 MEMORIAL EASTON

Covered Entity Details

Entity Name

MEMORIAL EASTON

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH210037

Entity Address

MEMORIAL HOSPITAL AT EASTON
219 SOUTH WASHINGTON STREET, MD 21601

Medicare Provider Number

210037

Participating Start Date

10/1/2022

Last Recertification Date

9/7/2023

Entity Termination Date

1/1/2024

Pharmacy Details

Pharmacy Name

HARRIS TEETER PHARMACY #380

Pharmacy Address

28528 MARLBORO AVE
EASTON, MD 21601

Pharmacy Comments

Contract Details

Approval Date

7/17/2023

Contract Begin Date

10/1/2023

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/1/2024
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Kenneth Kozel, President and CEO
(410) 822-1000 Ext: 5500

Contract Pharmacy Representative

Kroger Health
Eva Brumfield, Strategic Program Director
(651) 357-2109

Signed By Date

7/17/2023

340B Drug Pricing Program Database