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KROGER PHARMACY #010
DSH450330D OAKBEND MEDICAL CENTER
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Covered Entity Details
Entity Name
OAKBEND MEDICAL CENTER
Subdivision Name
Hospital of Surgical Excellence-Operating Room
Type
Disproportionate Share Hospital
340B ID
DSH450330D
Entity Address
1211 HIGHWAY 6
SUGAR LAND, TX 77478-4940
Medicare Provider Number
450330
Outpatient Facility Provider Number
Participating Start Date
7/1/2017
Last Recertification Date
9/11/2018
Entity Termination Date
10/1/2019
Pharmacy Details
Pharmacy Name
KROGER PHARMACY #010
Pharmacy Address
24401 BRAZOS TOWN CROSSING
ROSENBERG, TX 77471
Pharmacy Comments
Contract Details
Approval Date
7/17/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Jeffrey Hammel, CFO
(281) 341-4881
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
7/17/2017
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