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LA JARA PHARMACEUTICAL CENTER
CAH061308-00 Conejos County Hospital Corporation
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Covered Entity Details
Entity Name
Conejos County Hospital Corporation
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH061308-00
Entity Address
19021 US Hwy 285
La Jara, CO 81140
Medicare Provider Number
061308
Participating Start Date
1/1/2013
Last Recertification Date
8/21/2018
Entity Termination Date
7/1/2019
Pharmacy Details
Pharmacy Name
LA JARA PHARMACEUTICAL CENTER
Pharmacy Address
LA JARA PHARMACY
412 MAIN STREET
P.O. BOX 609
LA JARA, CO 81140
Pharmacy Comments
Contract Details
Approval Date
3/12/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/1/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Henry Garvin, CEO
(719) 587-1205
Contract Pharmacy Representative
Joseph T. Valdez, Owner/Partner
(719) 274-5109
Signed By Date
1/15/2013
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