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CITY MARKET PHARMACY #17
CAH061344-00 St. Thomas More Hospital
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Covered Entity Details
Entity Name
St. Thomas More Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH061344-00
Entity Address
1338 PHAY AVENUE
CANON CITY, CO 81212
Medicare Provider Number
061344
Participating Start Date
7/1/2019
Last Recertification Date
9/8/2024
Pharmacy Details
Pharmacy Name
CITY MARKET PHARMACY #17
Pharmacy Address
1703 FREMONT
CANON CITY, CO 81212
Pharmacy Comments
Contract Details
Approval Date
7/12/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kristi Olson, Chief Executive Officer
(719) 285-2039
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
7/12/2020
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