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KROGER PHARMACY #734
CAH511310-00 APPALACHIAN REGIONAL HEALTHCARE INC. D/B/A SUMMERS CO ARH HOSPITAL
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Covered Entity Details
Entity Name
APPALACHIAN REGIONAL HEALTHCARE INC. D/B/A SUMMERS CO ARH HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH511310-00
Entity Address
115 SUMMERS HOSPITAL ROAD
HINTON, WV 25951
Medicare Provider Number
511310
Participating Start Date
9/8/2010
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
KROGER PHARMACY #734
Pharmacy Address
406 JOHN RAINE DRIVE
RAINELLE, WV 25962
Pharmacy Comments
04/30/2012 changed address (was 500 Park Center); 04/09/2012 state correction (was WI)
Contract Details
Approval Date
10/9/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Maria Braman, Chief Medical Officer
(406) 465-8506
Contract Pharmacy Representative
Kroger Health
Eva Brumfield, Strategic Program Director
(651) 357-2109
Signed By Date
10/9/2023
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