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KROGER PHARMACY #734
CH033080 RAINELLE MEDICAL CENTER
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Covered Entity Details
Entity Name
RAINELLE MEDICAL CENTER
Subdivision Name
RAINELLE MEDICAL CENTER
Type
HRSA-Funded Health Center
340B ID
CH033080
Entity Address
176 Medical Center Drive
Rainelle, WV 25962-1013
Grant Number
H80CS18278
Participating Start Date
4/1/1996
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
KROGER PHARMACY #734
Pharmacy Address
406 JOHN RAINE DRIVE
RAINELLE, WV 25962
Pharmacy Comments
04/30/2012 changed address (was 500 Park Center); 04/09/2012 state correction (was WI)
Contract Details
Approval Date
12/28/2011
Contract Begin Date
12/28/2011
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
KRISTI ATHA-RADER, CEO
(304) 438-6188 Ext: 1006
Contract Pharmacy Representative
Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672
Signed By Date
12/6/2011
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