Contract Pharmacy Details

WALGREEN CO.
CAH061308-00 Conejos County Hospital Corporation

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

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 09912
1203 MAIN ST
ALAMOSA, CO 81101-2395

Pharmacy Comments

Contract Details

Approval Date

7/15/2015

Contract Begin Date

10/1/2015

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

Konnie Martin, CEO
(719) 587-1202

Contract Pharmacy Representative

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

Signed By Date

7/15/2015

340B Drug Pricing Program Database