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KING SOOPERS PHARMACY #130
CH08146AH PEAK VISTA COMMUNITY HEALTH CENTERS
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Covered Entity Details
Entity Name
PEAK VISTA COMMUNITY HEALTH CENTERS
Subdivision Name
Health Center at Academy, Suite 3500
Type
HRSA-Funded Health Center
340B ID
CH08146AH
Entity Address
3207 N Academy Blvd Ste 3500
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 #130
Pharmacy Address
3620 AUSTIN BLUFFS PARKWAY
COLORADO SPRINGS, CO 80918
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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