Contract Pharmacy Details

CORNELL PRESCRIPTION PHARMACY
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

CORNELL PRESCRIPTION PHARMACY

Pharmacy Address

FAIRVIEW ENTERPRISE INC.
TONY EUGENE JONES, RPH
2190 EAST 18TH AVENUE
DENVER, CO 80206

Pharmacy Comments

Contract Details

Approval Date

10/18/2013

Contract Begin Date

1/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

6/17/2016
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

CHRISTINE FORKNER, CFO
(303) 398-1004

Contract Pharmacy Representative

Tony Jones, Pharmacy Owner
(303) 388-1674

Signed By Date

10/18/2013

340B Drug Pricing Program Database