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WALGREEN CO.
SCH060013-00 Mercy Regional Medical Center
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Covered Entity Details
Entity Name
Mercy Regional Medical Center
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH060013-00
Entity Address
1010 Three Springs Blvd
Durango, CO 81301
Medicare Provider Number
060013
Participating Start Date
10/1/2013
Last Recertification Date
9/3/2019
Entity Termination Date
1/1/2020
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #12805
499 E HAMPDEN AVE STE 150
ENGLEWOOD, CO 80113
Pharmacy Comments
Contract Details
Approval Date
7/17/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/1/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jane Strobel, Chief Financial Officer
(970) 764-3909
Contract Pharmacy Representative
Mercy Regional Medical Center
Heather Loudon Howley, Pharmacy Director
(970) 764-2308
Signed By Date
7/17/2018
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