Contract Pharmacy Details

WALGREEN CO.
DSH060013 Mercy Hospital

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

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 10370
1671 E MAIN ST
CORTEZ, CO 81321-3033

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

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

10/14/2019

340B Drug Pricing Program Database