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THE KROGER CO., KS 113
CHC26510-02 Southwest Colorado Mental Health Center, Inc.
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Covered Entity Details
Entity Name
Southwest Colorado Mental Health Center, Inc.
Subdivision Name
Axis Health System Oral Health Clinic
Type
HRSA-Funded Health Center
340B ID
CHC26510-02
Entity Address
2530 Colorado Ave Unit 1A
Durango, CO 81301-4761
Grant Number
H80CS26510
Participating Start Date
7/1/2020
Last Recertification Date
1/31/2023
Entity Termination Date
4/1/2024
Pharmacy Details
Pharmacy Name
THE KROGER CO., KS 113
Pharmacy Address
1220 S. LIPAN STREET
DENVER, CO 80223
Pharmacy Comments
Contract Details
Approval Date
7/16/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Pamela Wise Romero, COO
(970) 335-2202
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
7/16/2020
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