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WALGREEN CO.
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
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #13968
7551 W. ALAMEDA AVE
LAKEWOOD, CO 80226
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
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/15/2022
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