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HARMONY EMERGENCY DEPARTMENT PHARMACY
DSH060010 POUDRE VALLEY HOSPITAL
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Covered Entity Details
Entity Name
POUDRE VALLEY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH060010
Entity Address
1024 S. LEMAY AVENUE
FT. COLLINS, CO 80524
Medicare Provider Number
060010
Participating Start Date
4/1/2022
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
HARMONY EMERGENCY DEPARTMENT PHARMACY
Pharmacy Address
POUDRE VALLEY HEALTH CARE INC
B125
4630 SNOW MESA DR
FORT COLLINS, CO 80528
Pharmacy Comments
Contract Details
Approval Date
7/12/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/14/2023
Agreement registered in error
Contacts
Covered Entity Signing Official
David Charles Thompson, Chief Financial Officer
(970) 237-7011
Contract Pharmacy Representative
UCHealth
Forrest Floyd, Pharmacist in Charge
(970) 237-8140
Signed By Date
7/12/2023
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