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KING SOOPERS PHARMACY #10
CH08073AM Metro Community Provider Network, Inc.
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Covered Entity Details
Entity Name
Metro Community Provider Network, Inc.
Subdivision Name
STRIDE CHC - Mobile Health Unit #3
Type
HRSA-Funded Health Center
340B ID
CH08073AM
Entity Address
3515 S Delaware St
Englewood, CO 80110-3529
Grant Number
H80CS00217
Participating Start Date
10/1/2022
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
1/10/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Santos vera, President/CEO
(949) 572-0958
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
1/10/2025
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