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WALGREEN CO.
CH080170A PUEBLO COMMUNITY HEALTH CENTER
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Covered Entity Details
Entity Name
PUEBLO COMMUNITY HEALTH CENTER
Subdivision Name
Colorado Avenue Clinic
Type
HRSA-Funded Health Center
340B ID
CH080170A
Entity Address
300 Colorado Ave
Pueblo, CO 81004-2006
Grant Number
H80CS00692
Participating Start Date
1/1/2000
Last Recertification Date
3/2/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #16531
15 N UNION BLVD UNIT 120
COLORADO SPRINGS, CO 80909
Pharmacy Comments
Contract Details
Approval Date
10/13/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Donald Moore, CEO
(719) 543-8718 Ext: 139
Contract Pharmacy Representative
Walgreen's
Oscar Campos, Analyst, 340B Client Relationship
(847) 964-7748
Signed By Date
10/13/2023
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