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THE KROGER CO., KS 113
CHC24170-00 HEARTLAND MEDICAL CLINIC, INC
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Covered Entity Details
Entity Name
HEARTLAND MEDICAL CLINIC, INC
Subdivision Name
HCHC - Medical Arts Building
Type
HRSA-Funded Health Center
340B ID
CHC24170-00
Entity Address
346 Maine Street, Suite 150
Lawrence, KS 66044
Grant Number
H80CS24170
Participating Start Date
7/1/2014
Last Recertification Date
1/31/2022
Entity Termination Date
4/1/2023
Pharmacy Details
Pharmacy Name
THE KROGER CO., KS 113
Pharmacy Address
1220 S. LIPAN STREET
DENVER, CO 80223
Pharmacy Comments
Contract Details
Approval Date
1/15/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/24/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Allie Nicholson, Chief Operating Officer
(785) 841-7297 Ext: 208
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
1/15/2019
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