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KROGER PHARMACY
DSH360189 MADISON HEALTH
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Covered Entity Details
Entity Name
MADISON HEALTH
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360189
Entity Address
210 NORTH MAIN STREET
LONDON, OH 43140
Medicare Provider Number
360189
Participating Start Date
1/1/2011
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
KROGER PHARMACY
Pharmacy Address
230 LAFAYETTE STREET
LONDON, OH 43140
Pharmacy Comments
Contract Details
Approval Date
6/28/2012
Contract Begin Date
6/28/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/21/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Michael S. Browning, Interim Chief Executive Officer
(740) 845-7015
Contract Pharmacy Representative
Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672
Signed By Date
6/15/2012
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