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WALGREEN CO.
CAH061303-00 EAST MORGAN COUNTY HOSPITAL
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Covered Entity Details
Entity Name
EAST MORGAN COUNTY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH061303-00
Entity Address
2400 EDISON STREET
BRUSH, CO 80723
Medicare Provider Number
061303
Participating Start Date
9/29/2010
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 09979
111 EAST PLATTE AVENUE
FT MORGAN, CO 80701
Pharmacy Comments
Contract Details
Approval Date
1/14/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
DENA KLOCKMAN, CHIEF FINANCIAL OFFICER
(308) 284-7263
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/14/2020
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