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CENTURA HEALTH PHARMACY SERVICES
DSH060013 Mercy Hospital
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Covered Entity Details
Entity Name
Mercy Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH060013
Entity Address
1010 THREE SPRINGS BLVD.
DURANGO, CO 81301
Medicare Provider Number
060013
Participating Start Date
1/1/2020
Last Recertification Date
9/10/2024
Pharmacy Details
Pharmacy Name
CENTURA HEALTH PHARMACY SERVICES
Pharmacy Address
2551 W. 84TH AVE
WESTMINSTER, CO 80031
Pharmacy Comments
Contract Details
Approval Date
10/21/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jane Strobel, Chief Financial Officer
(970) 764-3909
Contract Pharmacy Representative
CENTURA HEALTH PHARMACY SERVICES
Brian Morganfield, Pharmacy Manager
(303) 426-2360
Signed By Date
10/14/2019
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