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KROGER PHARMACY #L-315
DSH180143 SAINT JOSEPH EAST
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Covered Entity Details
Entity Name
SAINT JOSEPH EAST
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180143
Entity Address
150 NORTH EAGLE CREEK DRIVE
LEXINGTON, KY 40509
Medicare Provider Number
180143
Participating Start Date
1/1/2008
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
KROGER PHARMACY #L-315
Pharmacy Address
704 EUCLID AVENUE
LEXINGTON, KY 40502
Pharmacy Comments
Contract Details
Approval Date
9/27/2012
Contract Begin Date
9/27/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/6/2016
Agreement registered in error
Contacts
Covered Entity Signing Official
Mendy Evans, VP Finance
(859) 313-1694
Contract Pharmacy Representative
Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672
Signed By Date
9/7/2012
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