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KING SOOPERS PHARMACY #103
CH081460 PEAK VISTA COMMUNITY HEALTH CENTERS
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Covered Entity Details
Entity Name
PEAK VISTA COMMUNITY HEALTH CENTERS
Subdivision Name
Peak Vista Administrative Services Center
Type
HRSA-Funded Health Center
340B ID
CH081460
Entity Address
3205 N Academy Blvd Ste 130
Colorado Springs, CO 80917
Grant Number
H80CS00212
Participating Start Date
12/1/1992
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
KING SOOPERS PHARMACY #103
Pharmacy Address
2910 S ACADEMY BLVD
COLORADO SPRINGS, CO 80916
Pharmacy Comments
Contract Details
Approval Date
7/15/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
PAMELA J. MCMANUS, PRESIDENT AND CEO
(719) 344-6453
Contract Pharmacy Representative
Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672
Signed By Date
7/15/2014
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