Contract Pharmacy Details

WALGREEN CO.
DSH060107 NATIONAL JEWISH MEDICAL AND RESEARCH CENTER

Covered Entity Details

Entity Name

NATIONAL JEWISH MEDICAL AND RESEARCH CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH060107

Entity Address

1400 JACKSON STREET
DENVER, CO 80206

Medicare Provider Number

060107

Participating Start Date

10/1/2004

Last Recertification Date

9/3/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 10070
6360 E EVANS AVE
DENVER, CO 80222

Pharmacy Comments

Contract Details

Approval Date

10/10/2013

Contract Begin Date

1/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

2/27/2025
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

CHRISTINE FORKNER, CFO
(303) 398-1004

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

10/10/2013

340B Drug Pricing Program Database