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CVS PHARMACY, INC.
DSH060003 CENTURA LONGMONT UNITED HOSPITAL
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Covered Entity Details
Entity Name
CENTURA LONGMONT UNITED HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH060003
Entity Address
1950 WEST MOUNTAIN VIEW AVENUE
LONGMONT, CO 80501-3129
Medicare Provider Number
060003
Participating Start Date
7/1/2017
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
CVS PHARMACY, INC.
Pharmacy Address
CVS PHARMACY # 17295
551 S HOVER RD
LONGMONT, CO 80501
Pharmacy Comments
Contract Details
Approval Date
10/14/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Christina Johnson, CEO
(303) 651-5025
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/14/2019
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