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KROGER PHAMRACY L-895
DSH440039 Vanderbilt University Medical Center d/b/a Vanderbilt University Hospital and Clinic
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Covered Entity Details
Entity Name
Vanderbilt University Medical Center d/b/a Vanderbilt University Hospital and Clinic
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH440039
Entity Address
1211 MEDICAL CENTER DRIVE
NASHVILLE, TN 37232
Medicare Provider Number
440039
Participating Start Date
7/1/2002
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
KROGER PHAMRACY L-895
Pharmacy Address
2131 ABBOTT MARTIN ROAD
NASHVILLE, TN 37215
Pharmacy Comments
Contract Details
Approval Date
6/6/2012
Contract Begin Date
6/6/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/18/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Warren Beck, Chief Financial Officer
(615) 343-9908
Contract Pharmacy Representative
Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672
Signed By Date
5/24/2012
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