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KROGER COLUMBUS CENTRAL FILL #019
CAH151329-00 MARGARET MARY COMMUNITY HOSPITAL, INC.
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Covered Entity Details
Entity Name
MARGARET MARY COMMUNITY HOSPITAL, INC.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH151329-00
Entity Address
321 MITCHELL AVE
BATESVILLE, IN 47006-0226
Medicare Provider Number
151329
Participating Start Date
9/28/2010
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
KROGER COLUMBUS CENTRAL FILL #019
Pharmacy Address
2270 RICKENBACKER PKWY W
COLUMBUS, OH 43217
Pharmacy Comments
Contract Details
Approval Date
7/20/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
BRIAN DAEGER, CFO
(812) 933-5135
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
7/20/2016
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