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INTERMOUNTAIN SPECIALTY PHARMACY - DENVE
DSH060004 Brighton Community Hospital Association DBA: Intermountain Health Platte Valley Hospital
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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
INTERMOUNTAIN SPECIALTY PHARMACY - DENVE
Pharmacy Address
1830 N FRANKLIN ST
STE 190
DENVER, CO 80218
Pharmacy Comments
Contract Details
Approval Date
1/13/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
JOHN HICKS, PRESIDENT
(303) 498-1601
Contract Pharmacy Representative
SCL Health
Chris Wilson, Pharmacy Manager
(303) 318-1313 Ext: 61313
Signed By Date
1/13/2017
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