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BIOPLUS SPECIALTY PHARMACY SERVICES, LLC
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
BIOPLUS SPECIALTY PHARMACY SERVICES, LLC
Pharmacy Address
BIOPLUS SPECIALTY PHARMACY SERVICES, LLC
145 S 79TH ST STE 70
CHANDLER, AZ 85226
Pharmacy Comments
Contract Details
Approval Date
7/9/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
David Charles Thompson, Chief Financial Officer
(970) 237-7011
Contract Pharmacy Representative
BIOPLUS SPECIALTY PHARMACY
Bill Cook, Executive VP Sales and Business Development
(407) 388-5927 Ext: 4209
Signed By Date
7/9/2024
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