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UNIV OF COLORADO HOSPITAL
DSH060022 Memorial Health System
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Covered Entity Details
Entity Name
Memorial Health System
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH060022
Entity Address
1400 EAST BOULDER STREET
COLORADO SPRINGS, CO 80909
Medicare Provider Number
060022
Participating Start Date
7/1/2004
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
UNIV OF COLORADO HOSPITAL
Pharmacy Address
ATRIUM PHARMACY
12605 E 16TH AVE
AURORA, CO 80045
Pharmacy Comments
Contract Details
Approval Date
4/13/2021
Contract Begin Date
4/15/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Doreen Matson, Chief Financial Officer
(719) 365-2062
Contract Pharmacy Representative
University of Colorado Hospital Authority
Andrew Davis, Associate Director of Pharmacy
(303) 752-8222
Signed By Date
4/13/2021
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