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INTERMOUNTAIN PHARMACY #05
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 PHARMACY #05
Pharmacy Address
1375 E 19TH AVE
STE 1665
DENVER, CO 80218
Pharmacy Comments
Contract Details
Approval Date
10/17/2022
Contract Begin Date
10/24/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2023
OPA Terminated due to audit finding
Contacts
Covered Entity Signing Official
Troy Stoehr, VP of Finance
(303) 498-1606
Contract Pharmacy Representative
SCL Health Pharmacy Services
Rhiannon Longmore, Pharmacy Business Operations Manager
(303) 272-0922
Signed By Date
10/17/2022
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