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THE KROGER CO., KS 113
CH08022M COMMUNITY HEALTH CENTERS, INC.
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Covered Entity Details
Entity Name
COMMUNITY HEALTH CENTERS, INC.
Subdivision Name
Community Health Center, Inc. Ellis R. Shipp
Type
HRSA-Funded Health Center
340B ID
CH08022M
Entity Address
4535 S 5600 W
WEST VALLEY CITY, UT 84120-4639
Grant Number
H80CS00220
Participating Start Date
1/1/2016
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
1/13/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
DEXTER PEARCE, Executive Director
(801) 412-6920
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
1/13/2020
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