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KROGER PHARMACY L672
CHC00680-01 COMMUNITY HEALTH & EMERGENCY SERVICES, INC
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Covered Entity Details
Entity Name
COMMUNITY HEALTH & EMERGENCY SERVICES, INC
Subdivision Name
POPE COUNTY MEDICAL CLINIC
Type
HRSA-Funded Health Center
340B ID
CHC00680-01
Entity Address
217 S ADAMS STREET
GOLCONDA, IL 62938
Grant Number
H80CS00680
Participating Start Date
1/1/2009
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
KROGER PHARMACY L672
Pharmacy Address
45 PLAZA DR
ANNA, IL 62906-2034
Pharmacy Comments
Contract Details
Approval Date
8/20/2010
Contract Begin Date
8/23/2010
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
8/18/2010
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