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KROGER PHARMACY
DSH510022 CHARLESTON AREA MEDICAL CENTER (CAMC)
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Covered Entity Details
Entity Name
CHARLESTON AREA MEDICAL CENTER (CAMC)
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH510022
Entity Address
501 MORRIS STREET
CHARLESTON, WV 25301
Medicare Provider Number
510022
Participating Start Date
9/22/2005
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
KROGER PHARMACY
Pharmacy Address
500 DELAWARE AVE
CHARLESTON, WV 25302
Pharmacy Comments
Contract Details
Approval Date
1/14/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
LARRY HUDSON, EXECUTIVE VICE PRESIDENT AND CFO
(304) 388-7603
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
1/14/2016
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