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THE KROGER CO., KS 113
CHC12854-00 HealthCore Clinic Inc
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Covered Entity Details
Entity Name
HealthCore Clinic Inc
Subdivision Name
HealthCore Clinic Inc
Type
HRSA-Funded Health Center
340B ID
CHC12854-00
Entity Address
2707 E 21st St N
Wichita, KS 67214-2249
Grant Number
H80CS12854
Participating Start Date
1/1/2010
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
THE KROGER CO., KS 113
Pharmacy Address
1220 S. LIPAN STREET
DENVER, CO 80223
Pharmacy Comments
Contract Details
Approval Date
10/9/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/22/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
TERESA LOVELADY, CHIEF EXECUTIVE OFFICER
(316) 691-9404
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
10/9/2019
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