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CVS PHARMACY, INC.
DSH060103 AdventHealth Avista
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Covered Entity Details
Entity Name
AdventHealth Avista
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH060103
Entity Address
100 Health Park Drive
Louisville, CO 80027
Medicare Provider Number
060103
Participating Start Date
1/1/2012
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
CVS PHARMACY, INC.
Pharmacy Address
CVS PHARMACY # 16013
2800 PEARL ST
BOULDER, CO 80301
Pharmacy Comments
Contract Details
Approval Date
10/9/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Carol Travis, CFO
(720) 627-1230
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/9/2019
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