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KROGER PHARMACY
CH05711A THIRD STREET COMMUNITY CLINIC
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Covered Entity Details
Entity Name
THIRD STREET COMMUNITY CLINIC
Subdivision Name
Cornerstone OB/GYN
Type
HRSA-Funded Health Center
340B ID
CH05711A
Entity Address
770 Balgreen Dr
207
Mansfield, OH 44906-4106
Grant Number
H80CS00581
Participating Start Date
10/1/2010
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
KROGER PHARMACY
Pharmacy Address
1060 ASHLAND ROAD
MANSFIELD, OH 44905
Pharmacy Comments
Contract Details
Approval Date
8/20/2010
Contract Begin Date
10/1/2010
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
8/18/2010
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