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WALMART PHARMACY 10-5169
DSH060011 DENVER HEALTH MEDICAL CENTER
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Covered Entity Details
Entity Name
DENVER HEALTH MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH060011
Entity Address
777 BANNOCK ST
DENVER, CO 80204
Medicare Provider Number
060011
Participating Start Date
12/1/1992
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-5169
Pharmacy Address
2252 NORTH 8TH STREET
SUITE A
ROGERS, AR 72756
Pharmacy Comments
Contract Details
Approval Date
2/7/2023
Contract Begin Date
2/8/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kris Gaw, Chief Operating Officer
(303) 602-4985
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
2/7/2023
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