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KROGER LIMITED PARTNERSHIP I
CH07043AF Big Springs Medical Association, Inc
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Covered Entity Details
Entity Name
Big Springs Medical Association, Inc
Subdivision Name
Missouri Highlands Neelyville School Clinic
Type
HRSA-Funded Health Center
340B ID
CH07043AF
Entity Address
289 Broadway St
Neelyville, MO 63954-7176
Grant Number
H80CS00703
Participating Start Date
1/1/2023
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
KROGER LIMITED PARTNERSHIP I
Pharmacy Address
KROGER PHARMACY #386
2770 NORTH WESTWOOD
POPLAR BLUFF, MO 63901
Pharmacy Comments
Contract Details
Approval Date
10/12/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Karen R White, CEO
(573) 663-2313 Ext: 3965
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
10/12/2023
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