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WALGREEN CO.
DSH060064 Centura Porter Adventist Hospital
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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 # 09567
1235 E EVANS AVE
DENVER, CO 80210-4531
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
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