Contract Pharmacy Details

WALGREEN CO
HV00593 St. Mary's Hospital & Medical Center, Inc.

Covered Entity Details

Entity Name

St. Mary's Hospital & Medical Center, Inc.

Subdivision Name

Ryan White Part C HIV Clinic

Type

Ryan White Part C

340B ID

HV00593

Entity Address

2698 Patterson Road
Grand Junction, CO 81506

Grant Number

H76HA00593

Participating Start Date

10/1/2012

Last Recertification Date

2/24/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO

Pharmacy Address

DBA: WALGREENS #11187
316 W. ASPEN AVE.
FRUITA, CO 81521

Pharmacy Comments

Contract Details

Approval Date

1/26/2016

Contract Begin Date

4/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

3/10/2021
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Kristy Watkins, Program Director
(970) 298-1702

Contract Pharmacy Representative

Walgreens
Erin Kayser, Health Systems Solutions Director
(949) 280-7219

Signed By Date

1/26/2016

340B Drug Pricing Program Database