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KING SOOPERS PHARMACY #100
DSH060024 UNIVERSITY OF COLORADO HOSPITAL
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Covered Entity Details
Entity Name
UNIVERSITY OF COLORADO HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH060024
Entity Address
12605 E 16th Ave
AURORA, CO 80045
Medicare Provider Number
060024
Participating Start Date
12/1/1992
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
KING SOOPERS PHARMACY #100
Pharmacy Address
4910 S YOSEMITE
GREENWOOD VILLAGE, CO 80111
Pharmacy Comments
Contract Details
Approval Date
4/15/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/28/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Barbara Ann Carveth, Chief Financial Officer
(720) 848-7773
Contract Pharmacy Representative
Kroger
Katie Elfers, 340B Pharmacy Administrator
(513) 762-4850
Signed By Date
4/15/2022
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