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AMERITA INC.
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
AMERITA INC.
Pharmacy Address
7307 SOUTH REVERE PARKWAY
SUITE 200
CENTENNIAL, CO 80112-3931
Pharmacy Comments
Contract Details
Approval Date
10/21/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/28/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jane Strobel, Chief Financial Officer
(970) 764-3909
Contract Pharmacy Representative
Amerita
Daniel Van Valkenburg, Director 340B Program
(810) 434-2710
Signed By Date
10/14/2019
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