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KROGER COMPANY
RRC230037-00 Hillsdale Community Health Center
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Covered Entity Details
Entity Name
Hillsdale Community Health Center
Subdivision Name
Hillsdale Hospital
Type
Rural Referral Center
340B ID
RRC230037-00
Entity Address
168 S. Howell Street
Hillsdale, MI 49242
Medicare Provider Number
230037
Participating Start Date
7/1/2012
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
KROGER COMPANY
Pharmacy Address
290 W CARLTON
HILLSDALE, MI 49242
Pharmacy Comments
Contract Details
Approval Date
10/15/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/11/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Valerie Fetters, CFO
(517) 437-5232
Contract Pharmacy Representative
Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672
Signed By Date
10/15/2014
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