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KROGER PHARMACY #785
CH046840 FAMILY HEALTH CENTERS, INC.
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Covered Entity Details
Entity Name
FAMILY HEALTH CENTERS, INC.
Subdivision Name
FAMILY HEALTH CENTERS, INC./FAMILY HEALTH CENTER - PORTLAND
Type
HRSA-Funded Health Center
340B ID
CH046840
Entity Address
2215 Portland Ave
Attn:Pharmacy
Louisville, KY 40212-1033
Grant Number
H80CS00102
Participating Start Date
12/1/1992
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
KROGER PHARMACY #785
Pharmacy Address
4915 DIXIE HIGHWAY
LOUISVILLE, KY 40216
Pharmacy Comments
Contract Details
Approval Date
9/9/2011
Contract Begin Date
9/9/2011
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/1/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
BILL B WAGNER, CEO
(502) 778-4201
Contract Pharmacy Representative
Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672
Signed By Date
8/24/2011
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