Contract Pharmacy Details

WALGREEN CO
RWIID802221 COLORADO DEPT OF PUBLIC HEALTH & ENVIRONMENT

Covered Entity Details

Entity Name

COLORADO DEPT OF PUBLIC HEALTH & ENVIRONMENT

Subdivision Name

RYAN WHITE CARE PROGRAM

Type

Ryan White Part B ADAP Direct Purchase

340B ID

RWIID802221

Entity Address

4300 CHERRY CREEK DRIVE SOUTH
DENVER, CO 80246-1530

Grant Number

X07HA00056

Participating Start Date

4/1/1997

Last Recertification Date

2/11/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO

Pharmacy Address

DBA: WALGREENS #10739
15310 E COLFAX AVE
AURORA, CO 80011

Pharmacy Comments

Contract Details

Approval Date

1/9/2015

Contract Begin Date

4/1/2015

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

2/28/2016
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Tista Ghosh, Director, Disease Control and Environmental Epidemiology Division
(303) 692-2657

Contract Pharmacy Representative

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

Signed By Date

1/9/2015

340B Drug Pricing Program Database