340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
PLATTE VALLEY PHARMACY (DBA)
DSH060004 Brighton Community Hospital Association DBA: Intermountain Health Platte Valley Hospital
Print
Covered Entity Details
Entity Name
Brighton Community Hospital Association DBA: Intermountain Health Platte Valley Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH060004
Entity Address
1600 PRAIRIE CENTER PKWY.
BRIGHTON, CO 80601
Medicare Provider Number
060004
Participating Start Date
4/1/2006
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
PLATTE VALLEY PHARMACY (DBA)
Pharmacy Address
MEDIZINE MAN INC
1610 PRAIRIE CENTER PKWY STE 2110
BRIGHTON, CO 80601-4001
Pharmacy Comments
Contract Details
Approval Date
12/28/2011
Contract Begin Date
12/28/2011
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/30/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Harold Dupper, CFO
(303) 498-1601
Contract Pharmacy Representative
Tom Gierwatoski, Owner/ Pharmacy Manager
(303) 483-7455
Signed By Date
12/15/2011
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session