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WELLDYNERX
DSH060020 PARKVIEW MEDICAL CENTER
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Covered Entity Details
Entity Name
PARKVIEW MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH060020
Entity Address
400 WEST 16TH STREET
PUEBLO, CO 81003
Medicare Provider Number
060020
Participating Start Date
9/2/2008
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
WELLDYNERX
Pharmacy Address
7472 S. TUSCON WAY
SUITE 100-A
CENTENNIAL, CO 80112
Pharmacy Comments
Contract Details
Approval Date
4/15/2011
Contract Begin Date
4/15/2011
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
3/23/2011
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