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KROGER PHARMACY
CH053150 COMMUNITY HEALTH IMPROVEMENT CENTER
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Covered Entity Details
Entity Name
COMMUNITY HEALTH IMPROVEMENT CENTER
Subdivision Name
COMMUNITY HEALTH IMPROVEMENT CENTER
Type
HRSA-Funded Health Center
340B ID
CH053150
Entity Address
320 East Central Avenue
Decatur, IL 62521-4665
Grant Number
H80CS00681
Participating Start Date
12/1/1992
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
KROGER PHARMACY
Pharmacy Address
#250
1401 W. KING
DECATUR, IL 62522
Pharmacy Comments
Contract Details
Approval Date
1/23/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lois Tanner, CFO
(217) 877-6127
Contract Pharmacy Representative
Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672
Signed By Date
1/23/2017
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