Contract Pharmacy Details

KROGER PHARMACY #788
DSH510055 Cabell Huntington Hospital, Inc.

Covered Entity Details

Entity Name

Cabell Huntington Hospital, Inc.

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH510055

Entity Address

1340 Hal Greer Blvd.
Huntington, WV 25701-0195

Medicare Provider Number

510055

Participating Start Date

4/1/2005

Last Recertification Date

9/5/2024

Pharmacy Details

Pharmacy Name

KROGER PHARMACY #788

Pharmacy Address

6360 U.S. ROUTE 60
BARBOURSVILLE, WV 25504

Pharmacy Comments

Contract Details

Approval Date

4/7/2014

Contract Begin Date

7/1/2014

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

David M. Ward, SENIOR VP AND CfO
(304) 526-2274

Contract Pharmacy Representative

Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672

Signed By Date

4/7/2014

340B Drug Pricing Program Database