Contract Pharmacy Details

THE KROGER CO., KS 113
DSH170074 STORMONT VAIL HEALTH, FLINT HILLS LLC

Covered Entity Details

Entity Name

STORMONT VAIL HEALTH, FLINT HILLS LLC

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH170074

Entity Address

1102 ST. MARYS ROAD
JUNCTION CITY, KS 66441

Medicare Provider Number

170074

Participating Start Date

7/20/2020

Last Recertification Date

9/5/2024

Pharmacy Details

Pharmacy Name

THE KROGER CO., KS 113

Pharmacy Address

1220 S. LIPAN STREET
DENVER, CO 80223

Pharmacy Comments

Contract Details

Approval Date

7/20/2020

Contract Begin Date

10/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

12/31/2022
Ownership change

Contacts

Covered Entity Signing Official

Emily Emery-Shea, Asst CFO
(785) 210-3309

Contract Pharmacy Representative

Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875

Signed By Date

7/15/2020

340B Drug Pricing Program Database