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KROGER PHARMACY #784
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 #784
Pharmacy Address
704 EUCLID AVE
LEXINGTON, KY 40502
Pharmacy Comments
Contract Details
Approval Date
4/10/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ANN SMITH, CHIEF ADMINISTRATIVE OFFICER
(859) 323-5470
Contract Pharmacy Representative
Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672
Signed By Date
4/10/2015
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