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Walmart Pharmacy 10-7611
DSH060011 DENVER HEALTH MEDICAL CENTER
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Covered Entity Details
Entity Name
DENVER HEALTH MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH060011
Entity Address
777 BANNOCK ST
DENVER, CO 80204
Medicare Provider Number
060011
Participating Start Date
12/1/1992
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
4/13/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kris Gaw, Chief Operating Officer
(303) 602-4985
Contract Pharmacy Representative
Walmart
Nick Tallman, Sr. Director, Merchandise Operations – Pharmacy
(479) 371-0417
Signed By Date
4/13/2025
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