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WELLDYNERX LLC
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 LLC
Pharmacy Address
DBA HEALTHDYNE PHARMACY
500 EAGLES LANDING DR
LAKELAND, FL 33810
Pharmacy Comments
Contract Details
Approval Date
1/15/2016
Contract Begin Date
4/1/2016
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
Leslie Barnes, CFO
(719) 584-4534
Contract Pharmacy Representative
Patrick Rutherford, Senior Director of Pharmacy Operations
(888) 479-2000 Ext: 6526
Signed By Date
1/15/2016
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