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KROGER PHARMACY #722
CAH511321-00 ST. JOSEPHS HOSPITAL
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Covered Entity Details
Entity Name
ST. JOSEPHS HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH511321-00
Entity Address
1 AMALIA DRIVE
BUCKHANNON, WV 26201
Medicare Provider Number
511321
Participating Start Date
10/1/2015
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
KROGER PHARMACY #722
Pharmacy Address
80 SKYLINE PLAZA DR
BUCKHANNON, WV 26201
Pharmacy Comments
Contract Details
Approval Date
10/17/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Renee A. Hofer, Controller
(304) 473-2185
Contract Pharmacy Representative
Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672
Signed By Date
10/17/2016
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