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KROGER PHARMACY
CH05290N Community Action Committee of Pike County, The
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Covered Entity Details
Entity Name
Community Action Committee of Pike County, The
Subdivision Name
Valley View 23 North
Type
HRSA-Funded Health Center
340B ID
CH05290N
Entity Address
13800 US Highway 23
Waverly, OH 45690-9402
Grant Number
H80CS00399
Participating Start Date
11/3/2021
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
KROGER PHARMACY
Pharmacy Address
220 WAVERLY PLAZA
WAVERLY, OH 45690
Pharmacy Comments
Contract Details
Approval Date
10/8/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Keith Pitts, President and Chief Executive Officer
(216) 770-3409 Ext: 7009
Contract Pharmacy Representative
Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672
Signed By Date
10/8/2024
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