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WALGREEN CO.
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
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 04301
2975 FEDERAL
DENVER, CO 80211
Pharmacy Comments
Contract Details
Approval Date
1/12/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brad Membel, VP Finance, CFO
(303) 812-4936
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/12/2022
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