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THE KROGER CO., KS 113
CAH061318-01 KREMMLING MEMORIAL HOSPITAL DISTRICT
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Covered Entity Details
Entity Name
KREMMLING MEMORIAL HOSPITAL DISTRICT
Subdivision Name
dba Middle Park Health - Granby Campus
Type
Critical Access Hospital
340B ID
CAH061318-01
Entity Address
1000 GRANBY PARK DRIVE SOUTH
GRANBY, CO 80446
Medicare Provider Number
061318
Outpatient Facility Provider Number
Participating Start Date
1/1/2015
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
THE KROGER CO., KS 113
Pharmacy Address
1220 S. LIPAN STREET
DENVER, CO 80223
Pharmacy Comments
Contract Details
Approval Date
7/11/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brendan Gale, CFO
(970) 724-3111
Contract Pharmacy Representative
Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672
Signed By Date
7/11/2016
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