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THE KROGER CO.
STD85260 CAN Community Health, Inc
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Covered Entity Details
Entity Name
CAN Community Health, Inc
Subdivision Name
Scottsdale
Type
Sexually Transmitted Diseases
340B ID
STD85260
Entity Address
15425 N Greenway Hayden Loop
Suite A300
Scottsdale, AZ 85260
Grant Number
6 NU62PS924818-01-01
Participating Start Date
1/1/2020
Last Recertification Date
5/27/2024
Pharmacy Details
Pharmacy Name
THE KROGER CO.
Pharmacy Address
FRY'S PHARMACY #128
744 W CAMELBACK ROAD
PHOENIX, AZ 85013
Pharmacy Comments
Contract Details
Approval Date
1/22/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Richard E. Carlisle, President & CEO
(941) 366-0134 Ext: 11111
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
1/22/2020
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