Contract Pharmacy Details

THE KROGER CO.
STD850151 CAN Community Health, Inc

Covered Entity Details

Entity Name

CAN Community Health, Inc

Subdivision Name

Type

Sexually Transmitted Diseases

340B ID

STD850151

Entity Address

4244 N. 19th Avenue
Phoenix, AZ 85015

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

340B Drug Pricing Program Database