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WALGREEN CO
CH080130 SALUD FAMILY HEALTH, INC
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Covered Entity Details
Entity Name
SALUD FAMILY HEALTH, INC
Subdivision Name
SALUD FORT LUPTON
Type
HRSA-Funded Health Center
340B ID
CH080130
Entity Address
1115 2nd St
Fort Lupton, CO 80621-1745
Grant Number
H80CS00801
Participating Start Date
12/1/1992
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO
Pharmacy Address
DBA: WALGREENS #11862
743 S LEMAY AVENUE
FORT COLLINS, CO 80524
Pharmacy Comments
Contract Details
Approval Date
7/24/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/8/2022
Agreement registered in error
Contacts
Covered Entity Signing Official
John Santistevan, President/ CEO
(303) 892-6401
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/24/2017
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