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KROGER PHARMACY #014827
FQHCLA419D CENTERSTONE HEALTH SERVICES INC
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Covered Entity Details
Entity Name
CENTERSTONE HEALTH SERVICES INC
Subdivision Name
Grogan Family Medicine - Centerstone Health Services
Type
Health Center Program Look-Alike
340B ID
FQHCLA419D
Entity Address
1550 E State Road 44
Connersville, IN 47331-8293
Grant Number
LALCS40181
Participating Start Date
4/1/2024
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
KROGER PHARMACY #014827
Pharmacy Address
516 WEST 30TH STREET
CONNERSVILLE, IN 47331
Pharmacy Comments
Contract Details
Approval Date
4/9/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jennifer Harrison, CEO
(812) 350-8249
Contract Pharmacy Representative
Kroger Health
Eva Brumfield, Strategic Program Director
(651) 357-2109
Signed By Date
4/9/2025
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