Contract Pharmacy Details

KROGER PHARMACY #014420
CH048980 LEWIS COUNTY PRIMARY CARE CENTER, INC.

Covered Entity Details

Entity Name

LEWIS COUNTY PRIMARY CARE CENTER, INC.

Subdivision Name

Lewis County Primary Care Center, Inc.

Type

HRSA-Funded Health Center

340B ID

CH048980

Entity Address

211 KY 59
Building A
VANCEBURG, KY 41179

Grant Number

H80CS00106

Participating Start Date

1/1/1999

Last Recertification Date

2/26/2025

Pharmacy Details

Pharmacy Name

KROGER PHARMACY #014420

Pharmacy Address

381 MARKET SQUARE DRIVE
MAYSVILLE, KY 41056

Pharmacy Comments

Contract Details

Approval Date

4/3/2014

Contract Begin Date

7/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/30/2023
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

JERRY UGRIN, CEO
(606) 796-3029

Contract Pharmacy Representative

Signed By Date

4/3/2014

340B Drug Pricing Program Database