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CENTURA HEALTH PHARMACY SERVICES
RRC060015-00 ST ANTHONY HOSPITAL
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Covered Entity Details
Entity Name
ST ANTHONY HOSPITAL
Subdivision Name
Type
Rural Referral Center
340B ID
RRC060015-00
Entity Address
11600 W. 2ND PLACE
LAKEWOOD, CO 80228
Medicare Provider Number
060015
Participating Start Date
10/1/2022
Last Recertification Date
9/9/2024
Pharmacy Details
Pharmacy Name
CENTURA HEALTH PHARMACY SERVICES
Pharmacy Address
2551 W. 84TH AVE
WESTMINSTER, CO 80031
Pharmacy Comments
Contract Details
Approval Date
8/29/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kevin Wikoff, Market CFO
(719) 571-2498
Contract Pharmacy Representative
CENTURA HEALTH PHARMACY SERVICES
Brian Morganfield, Pharmacy Manager
(303) 426-2360
Signed By Date
7/15/2022
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