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KROGER PHARMACY
CAH151304-00 RUSH MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
RUSH MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH151304-00
Entity Address
1300 N. MAIN STREET
RUSHVILLE, IN 46173
Medicare Provider Number
151304
Participating Start Date
8/30/2010
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
KROGER PHARMACY
Pharmacy Address
202 S MAIN STREET
RUSHVILLE, IN 46173
Pharmacy Comments
Contract Details
Approval Date
1/14/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
BRADLEY SMITH, CEO
(765) 932-7513
Contract Pharmacy Representative
Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672
Signed By Date
1/14/2014
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