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SILVER SPRING PHARMACY
CAH061313-00 KIT CARSON COUNTY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
KIT CARSON COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH061313-00
Entity Address
286 16TH STREET
BURLINGTON, CO 80807
Medicare Provider Number
061313
Participating Start Date
4/1/2019
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
SILVER SPRING PHARMACY
Pharmacy Address
333 M AVE STE 200
LIMON, CO 80828-2239
Pharmacy Comments
Contract Details
Approval Date
1/15/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/31/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Susan Vaughan, CNO
(719) 346-5311 Ext: 2510
Contract Pharmacy Representative
Silver Spring Pharmacy
Susan Ferree, Pharmacist
(719) 775-0500
Signed By Date
1/15/2020
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