Contract Pharmacy Details

KROGER PHARMACY #16977
RRC510050-00 WHEELING HOSPITAL

Covered Entity Details

Entity Name

WHEELING HOSPITAL

Subdivision Name

Type

Rural Referral Center

340B ID

RRC510050-00

Entity Address

1 MEDICAL PARK
WHEELING, WV 26003

Medicare Provider Number

510050

Participating Start Date

4/1/2022

Last Recertification Date

8/23/2024

Pharmacy Details

Pharmacy Name

KROGER PHARMACY #16977

Pharmacy Address

1300 LAFAYETTE AVENUE
MOUNDSVILLE, WV 26041

Pharmacy Comments

Contract Details

Approval Date

4/14/2025

Contract Begin Date

7/1/2025

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Heidi Porter L Porter, Vice President of Quality and Regulatory Affairs
(304) 243-8377

Contract Pharmacy Representative

Kroger Health
Eva Brumfield, Strategic Program Director
(651) 357-2109

Signed By Date

4/14/2025

340B Drug Pricing Program Database