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THE KROGER CO., KS 113
CHC26644-01 Utah Partners for Health
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Covered Entity Details
Entity Name
Utah Partners for Health
Subdivision Name
Utah Partners for Health Mobile Clinic
Type
HRSA-Funded Health Center
340B ID
CHC26644-01
Entity Address
8446 S Harrison St
Midvale, UT 84047-3501
Grant Number
H80CS26644
Participating Start Date
7/1/2014
Last Recertification Date
2/28/2025
Pharmacy Details
Pharmacy Name
THE KROGER CO., KS 113
Pharmacy Address
1220 S. LIPAN STREET
DENVER, CO 80223
Pharmacy Comments
Contract Details
Approval Date
1/13/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/10/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kurt Micka, Executive Director
(801) 417-0131 Ext: 101
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
1/13/2020
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