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KING SOOPERS PHARMACY #90
CH08073AL METRO COMMUNITY PROVIDER NETWORK, INC.
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Covered Entity Details
Entity Name
METRO COMMUNITY PROVIDER NETWORK, INC.
Subdivision Name
STRIDE CHC - Horizon Community Middle School
Type
HRSA-Funded Health Center
340B ID
CH08073AL
Entity Address
3981 S Reservoir Rd Unit A
Aurora, CO 80013-3804
Grant Number
H80CS00217
Participating Start Date
7/1/2022
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
KING SOOPERS PHARMACY #90
Pharmacy Address
1725 SHERIDAN BLVD.
EDGEWATER, CO 80214
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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