Contract Pharmacy Details

SHOP-ALL
CAH061315-00 YUMA DISTRICT HOSPITAL

Covered Entity Details

Entity Name

YUMA DISTRICT HOSPITAL

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH061315-00

Entity Address

1000 WEST 8TH AVENUE
YUMA, CO 80759

Medicare Provider Number

061315

Participating Start Date

10/1/2015

Last Recertification Date

8/15/2024

Pharmacy Details

Pharmacy Name

SHOP-ALL

Pharmacy Address

315 E 8TH AVENUE
P.O. BOX 287
YUMA, CO 80759

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

10/9/2018
Pharmacy closed

Contacts

Covered Entity Signing Official

John R. Gardner, CEO
(970) 848-4601

Contract Pharmacy Representative

Linda Budman, Pharmacy Manager
(970) 848-5427

Signed By Date

1/15/2016