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CENTURA HEALTH PHARMACY AT PENROSE HOSPI
DSH060031 Penrose Hospital
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Covered Entity Details
Entity Name
Penrose Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH060031
Entity Address
2222 N Nevada Ave
Colorado Springs, CO 80907
Medicare Provider Number
060031
Participating Start Date
7/1/2017
Last Recertification Date
9/10/2024
Pharmacy Details
Pharmacy Name
CENTURA HEALTH PHARMACY AT PENROSE HOSPI
Pharmacy Address
2222 N NEVADA AVE
COLORADO SPRINGS, CO 80907
Pharmacy Comments
Contract Details
Approval Date
4/14/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Patrick T Ballard, Chief Financial Officer, Penrose-St. Francis Health Services
(719) 776-5911
Contract Pharmacy Representative
CENTURA HEALTH PHARMACY SERVICES
Brian Morganfield, Pharmacy Manager
(303) 426-2360
Signed By Date
4/14/2020
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