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WALGREEN CO
DSH060104 St. Anthony North Hospital
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Covered Entity Details
Entity Name
St. Anthony North Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH060104
Entity Address
14300 Orchard Pkwy
Westminster, CO 80023
Medicare Provider Number
060104
Participating Start Date
10/1/2013
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO
Pharmacy Address
DBA: WALGREENS #05837
4351 E. 104TH AVE
THORNTON, CO 80233
Pharmacy Comments
Contract Details
Approval Date
4/12/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Carol Travis, CFO
(720) 627-1230
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/12/2019
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