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WALGREEN CO.
DSH060015 ST ANTHONY HOSPITAL
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Covered Entity Details
Entity Name
ST ANTHONY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH060015
Entity Address
11600 W. 2ND PLACE
LAKEWOOD, CO 80228
Medicare Provider Number
060015
Participating Start Date
1/1/2019
Last Recertification Date
8/20/2019
Entity Termination Date
1/1/2020
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 09566
12880 W ALAMEDA PKWY
LAKEWOOD, CO 80228-3115
Pharmacy Comments
Contract Details
Approval Date
4/15/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Matthew P. Leary, Market VFO
(303) 643-1022
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/15/2019
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