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KROGER PHARMACY
CH05711Q THIRD STREET COMMUNITY CLINIC INC
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Covered Entity Details
Entity Name
THIRD STREET COMMUNITY CLINIC INC
Subdivision Name
Community Counseling and Wellness Centers-Bucyrus
Type
HRSA-Funded Health Center
340B ID
CH05711Q
Entity Address
2458 Stetzer Rd
Bucyrus, OH 44820-2066
Grant Number
H80CS00581
Participating Start Date
1/1/2024
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
KROGER PHARMACY
Pharmacy Address
1060 ASHLAND ROAD
MANSFIELD, OH 44905
Pharmacy Comments
Contract Details
Approval Date
1/11/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Peggy Anderson, CEO
(419) 526-7880
Contract Pharmacy Representative
Kroger Health
Eva Brumfield, Strategic Program Director
(651) 357-2109
Signed By Date
1/11/2024
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