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THE KROGER CO., KS 113
CH074010 KONZA PRAIRIE COMMUNITY HEALTH CENTER INC
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Covered Entity Details
Entity Name
KONZA PRAIRIE COMMUNITY HEALTH CENTER INC
Subdivision Name
KONZA PRAIRIE COMMUNITY HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH074010
Entity Address
361 Grant Ave
Junction City, KS 66441-4201
Grant Number
H80CS00210
Participating Start Date
1/1/1997
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
THE KROGER CO., KS 113
Pharmacy Address
1220 S. LIPAN STREET
DENVER, CO 80223
Pharmacy Comments
Contract Details
Approval Date
7/11/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lee Wolf, Chief Executive Officer
(785) 238-4711 Ext: 1000
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
7/11/2017
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