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ROCKY MOUNTAIN PHARMACY OF ESTES PARK
CAH061312-00 ESTES PARK HEALTH
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Covered Entity Details
Entity Name
ESTES PARK HEALTH
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH061312-00
Entity Address
555 PROSPECT AVE.
ESTES PARK, CO 80517
Medicare Provider Number
061312
Participating Start Date
1/1/2011
Last Recertification Date
9/10/2024
Pharmacy Details
Pharmacy Name
ROCKY MOUNTAIN PHARMACY OF ESTES PARK
Pharmacy Address
455 E WONDERVIEW AVE # B1
ESTES PARK, CO 80517
Pharmacy Comments
Contract Details
Approval Date
7/11/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Vern Carda, CEO
(970) 586-2317
Contract Pharmacy Representative
Rocky Mountain Pharmacy
Megan Orsburn, Pharmacist
(970) 586-5577
Signed By Date
7/11/2024
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