340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
KROGER DRUGSTORE #487
CAH111335-00 LIBERTY REGIONAL MEDICAL CENTER
Print
Covered Entity Details
Entity Name
LIBERTY REGIONAL MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH111335-00
Entity Address
462 E.G. MILES PARKWAY
HINESVILLE, GA 31313
Medicare Provider Number
111335
Participating Start Date
1/1/2011
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
KROGER DRUGSTORE #487
Pharmacy Address
555 WEST OGLETHORPE HWY
HINESVILLE, GA 31313
Pharmacy Comments
Contract Details
Approval Date
11/17/2011
Contract Begin Date
11/25/2011
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/15/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
SCOTT KROELL, CEO
(912) 369-9441
Contract Pharmacy Representative
Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672
Signed By Date
11/18/2011
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session