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THE KROGER CO., KS 113
CHC08239-00 PRAIRIESTAR HEALTH CENTER INC
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Covered Entity Details
Entity Name
PRAIRIESTAR HEALTH CENTER INC
Subdivision Name
PRAIRIESTAR HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CHC08239-00
Entity Address
2700 E 30TH AVE
HUTCHINSON, KS 67502
Grant Number
H80CS08239
Participating Start Date
4/1/2012
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
THE KROGER CO., KS 113
Pharmacy Address
1220 S. LIPAN STREET
DENVER, CO 80223
Pharmacy Comments
Contract Details
Approval Date
7/14/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/22/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Bryant Anderson, Chief Executive Officer
(620) 802-0035
Contract Pharmacy Representative
Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672
Signed By Date
7/14/2016
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