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KING SOOPERS PHARMACY #103
CH08146AJ PEAK VISTA COMMUNITY HEALTH CENTERS
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Covered Entity Details
Entity Name
PEAK VISTA COMMUNITY HEALTH CENTERS
Subdivision Name
Convenient Care Center
Type
HRSA-Funded Health Center
340B ID
CH08146AJ
Entity Address
3205 N. Academy STE 100
Colorado Springs, CO 80917
Grant Number
H80CS00212
Participating Start Date
10/1/2013
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
KING SOOPERS PHARMACY #103
Pharmacy Address
2910 S ACADEMY BLVD
COLORADO SPRINGS, CO 80916
Pharmacy Comments
Contract Details
Approval Date
10/13/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Joel Tanaka, Chief Medical Officer
(719) 344-6530
Contract Pharmacy Representative
Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672
Signed By Date
10/13/2023
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