Contract Pharmacy Details

WALGREEN CO.
DSH060064 Centura Porter Adventist Hospital

Covered Entity Details

Entity Name

Centura Porter Adventist Hospital

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH060064

Entity Address

2525 SOUTH DOWNING STREET
DENVER, CO 80210

Medicare Provider Number

060064

Participating Start Date

7/1/2022

Last Recertification Date

8/29/2022

Entity Termination Date

7/1/2023

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 03207
4001 E. 120TH AVENUE
THORNTON, CO 80233

Pharmacy Comments

Contract Details

Approval Date

4/27/2022

Contract Begin Date

7/1/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2023
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Matthew P. Leary, Market VFO
(303) 643-1022

Contract Pharmacy Representative

WALGREENS CO
KARL MEEHAN, VICE PRESIDENT,HEALTH SYSTEMS PROGRAMS
(847) 315-2663

Signed By Date

4/14/2022

340B Drug Pricing Program Database