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KROGER PHARMACY #402
CH0417140 Christ Community Health Services, Inc.
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Covered Entity Details
Entity Name
Christ Community Health Services, Inc.
Subdivision Name
THIRD STREET HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH0417140
Entity Address
3362 S 3rd St
MEMPHIS, TN 38109-2944
Grant Number
H80CS00881
Participating Start Date
7/1/2003
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
KROGER PHARMACY #402
Pharmacy Address
1759 UNION AVE
MEMPHIS, TN 38104
Pharmacy Comments
Contract Details
Approval Date
1/15/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Shantelle Leatherwood, CEO
(901) 842-2393
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
1/15/2018
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