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THE KROGER CO
CH05320AH HealthNet, Inc.
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Covered Entity Details
Entity Name
HealthNet, Inc.
Subdivision Name
Crispus Attucks Clinic
Type
HRSA-Funded Health Center
340B ID
CH05320AH
Entity Address
1140 Dr Martin Luther King Jr St
Rm 615
Indianapolis, IN 46202-2221
Grant Number
H80CS00114
Participating Start Date
1/1/2022
Last Recertification Date
2/26/2025
Pharmacy Details
Pharmacy Name
THE KROGER CO
Pharmacy Address
KROGER PHARMACY #905
8150 ROCKVILLE RD
INDIANAPOLIS, IN 46214
Pharmacy Comments
Contract Details
Approval Date
10/13/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Varon Edward Cantrell, Chief Medical Officer
(317) 957-2015
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
10/13/2023
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