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KROGER PHARMACY L-766
DSH180067 UNIVERSITY OF KENTUCKY
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Covered Entity Details
Entity Name
UNIVERSITY OF KENTUCKY
Subdivision Name
UK Chandler Hospital
Type
Disproportionate Share Hospital
340B ID
DSH180067
Entity Address
800 ROSE STREET
LEXINGTON, KY 40536
Medicare Provider Number
180067
Participating Start Date
12/1/1992
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
KROGER PHARMACY L-766
Pharmacy Address
200 EAST BRANNON ROAD
NICHOLASVILLE, KY 40356
Pharmacy Comments
Contract Details
Approval Date
11/28/2012
Contract Begin Date
1/1/2013
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Gary Johnson, Chief Pharmacy Officer
(859) 323-5925
Contract Pharmacy Representative
Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672
Signed By Date
10/15/2012
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