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THE KROGER CO., KS 113
CHC24170-05 Heartland Medical Clinic, Incorporated
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Covered Entity Details
Entity Name
Heartland Medical Clinic, Incorporated
Subdivision Name
Heartland at Panda Pediatrics
Type
HRSA-Funded Health Center
340B ID
CHC24170-05
Entity Address
1803 W 6th St
Lawrence, KS 66044-1710
Grant Number
H80CS24170
Participating Start Date
4/1/2021
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
THE KROGER CO., KS 113
Pharmacy Address
1220 S. LIPAN STREET
DENVER, CO 80223
Pharmacy Comments
Contract Details
Approval Date
7/15/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/24/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Julie Boden Schmidt, Chief Executive Officer
(785) 841-7297
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
7/15/2021
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