Contract Pharmacy Details

KROGER PHARMACY L763
CHC28961-00 SHAWNEE CHRISTIAN HEALTHCARE CENTER, INC.

Covered Entity Details

Entity Name

SHAWNEE CHRISTIAN HEALTHCARE CENTER, INC.

Subdivision Name

Shawnee Christian Healthcare Center, Inc.

Type

HRSA-Funded Health Center

340B ID

CHC28961-00

Entity Address

234 Amy Ave.
Louisville, KY 40212-2522

Grant Number

H80CS28961

Participating Start Date

4/1/2016

Last Recertification Date

2/20/2025

Pharmacy Details

Pharmacy Name

KROGER PHARMACY L763

Pharmacy Address

520 N. 35TH STREET
LOUISVILLE, KY 40212

Pharmacy Comments

Contract Details

Approval Date

7/8/2016

Contract Begin Date

10/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/23/2018
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Phyllis Platt, CEO
(502) 778-0001

Contract Pharmacy Representative

Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672

Signed By Date

7/8/2016

340B Drug Pricing Program Database