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THE KROGER CO., KS 113
CHC24176-00 OLATHE COMMUNITY CLINIC, INC.
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Covered Entity Details
Entity Name
OLATHE COMMUNITY CLINIC, INC.
Subdivision Name
Olathe Community Clinic, Inc.
Type
HRSA-Funded Health Center
340B ID
CHC24176-00
Entity Address
308 Main Street
Olathe, CO 81425
Grant Number
H80CS24176
Participating Start Date
4/1/2014
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
THE KROGER CO., KS 113
Pharmacy Address
1220 S. LIPAN STREET
DENVER, CO 80223
Pharmacy Comments
Contract Details
Approval Date
10/17/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
DEBORAH HARRISON-ZARKIS, CEO
(970) 263-1707
Contract Pharmacy Representative
Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672
Signed By Date
10/17/2016
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