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KING SOOPERS PHARMACY #10
CH080730 METRO COMMUNITY PROVIDER NETWORK, INC.
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Covered Entity Details
Entity Name
METRO COMMUNITY PROVIDER NETWORK, INC.
Subdivision Name
STRIDE CHC- Peoria
Type
HRSA-Funded Health Center
340B ID
CH080730
Entity Address
3292 Peoria St
Aurora, CO 80010
Grant Number
H80CS00217
Participating Start Date
12/1/1992
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
KING SOOPERS PHARMACY #10
Pharmacy Address
15250 EAST MISSISSIPPI
AURORA, CO 80012
Pharmacy Comments
Contract Details
Approval Date
10/17/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ben Wiederholt, CEO
(303) 761-1977 Ext: 1103
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
10/17/2021
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