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AMERITA INC.
DSH060028 Saint Joseph Hospital, Inc. DBA Intermountain Health Saint Joseph Hospital
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Covered Entity Details
Entity Name
Saint Joseph Hospital, Inc. DBA Intermountain Health Saint Joseph Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH060028
Entity Address
1375 EAST 19TH AVENUE
DENVER, CO 80218
Medicare Provider Number
060028
Participating Start Date
7/1/2016
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
AMERITA INC.
Pharmacy Address
7307 SOUTH REVERE PARKWAY
SUITE 200
CENTENNIAL, CO 80112-3931
Pharmacy Comments
Contract Details
Approval Date
10/16/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/23/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Alice Rigdon, VP Finance
(303) 812-4926
Contract Pharmacy Representative
Amerita
Daniel Van Valkenburg, Director 340B Program
(810) 434-2710
Signed By Date
10/16/2019
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