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BOULDER HEALTH CENTER PHARMACY
DSH060024 UNIVERSITY OF COLORADO HOSPITAL
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Covered Entity Details
Entity Name
UNIVERSITY OF COLORADO HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH060024
Entity Address
12605 E 16th Ave
AURORA, CO 80045
Medicare Provider Number
060024
Participating Start Date
12/1/1992
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
BOULDER HEALTH CENTER PHARMACY
Pharmacy Address
5495 ARAPAHOE AVE
SUITE 101
BOULDER, CO 80303-1260
Pharmacy Comments
Contract Details
Approval Date
10/17/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
Barbara Ann Carveth, Chief Financial Officer
(720) 848-7773
Contract Pharmacy Representative
UC Health
Brian Bennett, Pharmacy Manager
(303) 499-2879
Signed By Date
10/17/2017
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