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KROGER PHARMACY
DSH180048 EPHRAIM MCDOWELL REGIONAL MEDICAL CENTER, INC.
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Covered Entity Details
Entity Name
EPHRAIM MCDOWELL REGIONAL MEDICAL CENTER, INC.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180048
Entity Address
217 SOUTH THIRD STREET
DANVILLE, KY 40422
Medicare Provider Number
180048
Participating Start Date
10/1/2004
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
KROGER PHARMACY
Pharmacy Address
200 SKYWATCH DRIVE
DANVILLE, KY 40422
Pharmacy Comments
Contract Details
Approval Date
10/11/2012
Contract Begin Date
10/11/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
BILL SNAPP, CFO
(859) 239-2435
Contract Pharmacy Representative
Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672
Signed By Date
9/20/2012
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