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KROGER PHARMACY
DSH180088 NORTON HOSPITALS, INC
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Covered Entity Details
Entity Name
NORTON HOSPITALS, INC
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180088
Entity Address
200 East Chestnut Street
LOUISVILLE, KY 40202
Medicare Provider Number
180088
Participating Start Date
1/1/2004
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
KROGER PHARMACY
Pharmacy Address
12501 SHELBYVILLE ROAD
LOUISVILLE, KY 40243
Pharmacy Comments
Contract Details
Approval Date
7/18/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
MICHAEL W. GOUGH, CHIEF FINANCIAL OFFICER
(502) 420-2212
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
7/18/2017
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