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KROGER PHARMACY #010
DSH450330E OAKBEND MEDICAL CENTER
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Covered Entity Details
Entity Name
OAKBEND MEDICAL CENTER
Subdivision Name
River Oaks Surgery Center of OakBend Health System-Operating Room
Type
Disproportionate Share Hospital
340B ID
DSH450330E
Entity Address
4120 Southwest Freeway
Suite 100
Houston, TX 77027
Medicare Provider Number
450330
Outpatient Facility Provider Number
Participating Start Date
4/1/2024
Last Recertification Date
8/22/2024
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
6/11/2019
Business decision by covered entity and/or pharmacy
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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