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WALGREEN CO.
RRC060064-00 AdventHealth Porter
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Covered Entity Details
Entity Name
AdventHealth Porter
Subdivision Name
Type
Rural Referral Center
340B ID
RRC060064-00
Entity Address
2525 South Downing Street
Denver, CO 80210
Medicare Provider Number
060064
Participating Start Date
7/1/2023
Last Recertification Date
9/11/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 03207
4001 E. 120TH AVENUE
THORNTON, CO 80233
Pharmacy Comments
Contract Details
Approval Date
4/17/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Andrew Whitlock, CFO
(303) 673-1256
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/17/2023
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