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THE KROGER CO., KS 113
DSH060011 DENVER HEALTH MEDICAL CENTER
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Covered Entity Details
Entity Name
DENVER HEALTH MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH060011
Entity Address
777 BANNOCK ST
DENVER, CO 80204
Medicare Provider Number
060011
Participating Start Date
12/1/1992
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
THE KROGER CO., KS 113
Pharmacy Address
1220 S. LIPAN STREET
DENVER, CO 80223
Pharmacy Comments
Contract Details
Approval Date
2/1/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
PEG BURNETTE, CFO, DENVER HEALTH AND HOSPITAL AUTHORITY
(303) 602-4964
Contract Pharmacy Representative
Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672
Signed By Date
2/1/2017
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