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KROGER PHARMACY #902
RRC180035-00 ST ELIZABETH HEALTHCARE
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Covered Entity Details
Entity Name
ST ELIZABETH HEALTHCARE
Subdivision Name
Type
Rural Referral Center
340B ID
RRC180035-00
Entity Address
1 MEDICAL VILLAGE DRIVE
EDGEWOOD, KY 41017-3403
Medicare Provider Number
180035
Participating Start Date
4/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
KROGER PHARMACY #902
Pharmacy Address
4530 EASTGATE BOULEVARD, SUITE #500
CINCINNATI, OH 45245-1256
Pharmacy Comments
Contract Details
Approval Date
1/27/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lori Ritchey-Baldwin, CFO
(859) 655-1642
Contract Pharmacy Representative
Kroger Health
Eva Brumfield, Strategic Program Director
(651) 357-2109
Signed By Date
1/14/2025
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