Covered Entity Details

CH08395A MOUNTAINLANDS COMMUNITY HEALTH CENTER (Active) - information as of 6/6/2025 12:41:02 PM

Main Details

Name

MOUNTAINLANDS COMMUNITY HEALTH CENTER

Subdivision Name

Mountainlands Community Health Center - Payson 2

Type

HRSA-Funded Health Center

Site ID

BPS-H80-033434

340B ID

CH08395A

Grant Number

H80CS00213

Additional Details

Current Program Status

Active

Registration Date

8/22/2005

Participating Start Date

9/9/2005

Participating Approval Date

8/26/2005

Last Recertification Date

2/12/2025

Contacts

Authorizing Official

Mountainlands Community Health Center, Inc.
Todd Bailey, Executive Director
(801) 429-2000 Ext: 1155

Primary Contact

Mountainlands Community Health Center
Ronda Yorgason, Director of Operations
(801) 855-0153

Addresses

Street Address

285 N 1250 E Ste 103
PAYSON, UT 84651

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
UT		1437364882,1427075134

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
Contract Detail	SMITHS FOOD & DRUG CTRS	SMITH'S DRUG KING PHARMACY #75	632 SOUTH 100 WEST	PAYSON	UT	84651	09/09/2005	09/09/2005		10/16/2024	10/28/2024

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH083950	Active	BPS-H80-008780	MOUNTAINLANDS COMMUNITY HEALTH CENTER, INC	Mountainlands Community Health Center Main Site Clinic	589 S. State Street	Provo	UT
CH08395A	Active	BPS-H80-033434	MOUNTAINLANDS COMMUNITY HEALTH CENTER	Mountainlands Community Health Center - Payson 2	285 N 1250 E Ste 103	PAYSON	UT
CH08395B	Active	BPS-H80-013490	MOUNTAINLANDS COMMUNITY HEALTH CENTER, INC	Mountainlands Community Health Center - Vernal	1680 West Highway 40, STE 201	Vernal	UT
CH08395C	Active	BPS-H80-013756	MOUNTAINLANDS COMMUNITY HEALTH CENTER, INC	Mountainlands Family Health Center--Wasatch	750 North 200 West, Suite 201	Provo	UT
CH08395D	Active	BPS-H80-013946	MOUNTAINLANDS COMMUNITY HEALTH CENTER, INC	Mountainlands Family Health Center Vernal Dental Clinic	133 S 500 E	VERNAL	UT
CH08395E	Active	BPS-H80-014977	MOUNTAINLANDS COMMUNITY HEALTH CENTER, INC	East Bay Health Center	299 East 900 South, Suite 101	Provo	UT

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH083950	HEALTHY OPTIONS INC	DBA POSTAL PRESCRIPTION SVCS	3500 SE 26TH AVE PO BOX 2718	PORTLAND	OR	97202	04/01/2020	08/17/2021
CH083950	KENTUCKY CENTRAL FILL FACILITY, L-010	5594 SHEPHERDSVILLE ROAD		LOUISVILLE	KY	40228-1012	04/01/2020	08/17/2021
CH083950	KROGER COLUMBUS CENTRAL FILL #019	2270 RICKENBACKER PKWY W		COLUMBUS	OH	43217	04/01/2020	08/17/2021
CH083950	SMITH MANAGEMENT CORP	DBA SMITH'S PHARMACY #69	1174 WEST 600 NORTH	SALT LAKE CITY	UT	84116	04/01/2016	07/07/2020
CH083950	SMITH'S DRUG #44	DBA SMITHS FOOD KING #1	876 E 8TH S	SALT LAKE CITY	UT	84102	04/01/2016	07/07/2020
CH083950	SMITH'S FOOD & DRUG CENTERS	DBA: SMITH'S PHARMACY #80	828 SOUTH 900 WEST	SALT LAKE CITY	UT	84104	04/01/2016	07/07/2020
CH083950	SMITH'S FOOD & DRUG CENTERS	SMITH'S PHARMACY # 85	980 EAST FORT UNION BLVD.	MIDVALE	UT	84047	04/01/2016	07/07/2020
CH083950	SMITH'S FOOD & DRUG CTR	SMITH'S FOOD & DRUG #144	45 SOUTH STATE	OREM	UT	84057	04/01/2016	08/17/2021
CH083950	SMITH'S FOOD AND DRUG #189	20 NORTH BLUFF STREET		SAINT GEORGE	UT	84770	04/01/2016	07/07/2020
CH083950	SMITH'S FOOD AND DRUG CENTERS INC	SMITH'S PHARMACY 82	1080 WEST HIGHWAY 40	VERNAL	UT	84078	04/01/2016	10/16/2024
CH08395B	SMITH'S FOOD AND DRUG CENTERS INC	SMITH'S PHARMACY 82	1080 WEST HIGHWAY 40	VERNAL	UT	84078	07/01/2014	10/16/2024
CH08395D	SMITH'S FOOD AND DRUG CENTERS INC	SMITH'S PHARMACY 82	1080 WEST HIGHWAY 40	VERNAL	UT	84078	04/01/2016	10/16/2024
CH083950	SMITH'S FOOD KING NO 1	SMITH'S DRUG KING PHARMACY #30	4275 HARRISON BLVD	OGDEN	UT	84403	04/01/2016	07/07/2020
CH083950	SMITH'S MANAGEMENT CORP DBA	SMITH'S FOOD & DRUG #66	PHARMACY 4065 SOUTH REDWOOD ROAD	SALT LAKE CITY	UT	84123	04/01/2016	07/07/2020
CH083950	SMITH'S PHARMACY	SMITH'S FOOD & DRUG #42	633 S. MAIN	CEDAR CITY	UT	84720	04/01/2016	07/07/2020
CH083950	SMITH'S PHARMACY #28	922 E. 2100 S.		SALT LAKE CITY	UT	84106	04/01/2016	07/07/2020
CH083950	SMITH'S PHARMACY #444	555 S. 200 W.		BOUNTIFUL	UT	84010	07/01/2016	07/07/2020
CH083950	SMITH'S PHARMACY #477	750 N. MAIN ST.		LOGAN	UT	84321	04/01/2016	04/15/2016
CH083950	SMITH'S PHARMACY #87	442 N 175 E		LOGAN	UT	84321	04/01/2016	07/07/2020
CH083950	SMITH'S PHARMACY #94	455 SOUTH 500 EAST		SALT LAKE CITY	UT	84102	04/01/2016	07/07/2020
CH083950	SMITHS FOOD & DRUG CTR INC	SMITH'S PHARMACY #147	5620 W 4100 SO	WEST VALLEY CITY	UT	84128	04/01/2016	07/07/2020
CH083950	SMITHS FOOD & DRUG CTRS	SMITH'S DRUG KING PHARMACY #75	632 SOUTH 100 WEST	PAYSON	UT	84651	04/01/2016	10/16/2024
CH083950	SMITHS FOOD & DRUG CTRS	DBA SMITH'S FOOD & DRUG #133	845 EAST 4500 SOUTH	SALT LAKE CITY	UT	84107	04/01/2016	07/07/2020
CH083950	SMITHS FOOD & DRUG CTRS	SMITH'S FOOD DRUG #149	1170 EAST GENTILE	LAYTON	UT	84040	04/01/2016	07/07/2020
CH083950	SMITHS FOOD & DRUG CTRS	SMITH'S PHARMACY #178	156 SOUTH MAIN	BRIGHAM CITY	UT	84302	04/01/2016	07/07/2020
CH08395A	SMITHS FOOD & DRUG CTRS	SMITH'S DRUG KING PHARMACY #75	632 SOUTH 100 WEST	PAYSON	UT	84651	09/09/2005	10/16/2024
CH083950	SMITHS FOOD & DRUG CTRS	DBA SMITH'S FOOD & DRUG #136	350 NORTH FREEDOM BOULEVARD	PROVO	UT	84601	07/01/2020	10/16/2024
CH08395E	SMITHS FOOD & DRUG CTRS	DBA SMITH'S FOOD & DRUG #136	350 NORTH FREEDOM BOULEVARD	PROVO	UT	84601	04/01/2023	10/16/2024
CH083950	THE KROGER CO., KS 113	1220 S. LIPAN STREET		DENVER	CO	80223	04/01/2020	08/17/2021
CH083950	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	04/01/2021	07/15/2024
CH083950	WAL-MART PHARMACY 10-1572	1851 WEST HWY 40		VERNAL	UT	84078	04/01/2021	07/15/2024
CH08395D	WAL-MART PHARMACY 10-1572	1851 WEST HWY 40		VERNAL	UT	84078	04/01/2023	10/16/2024
CH083950	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/01/2021	07/15/2024
CH083950	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2023	07/15/2024
CH083950	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024	07/15/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	1/29/2024 5:02:34 PM	2/12/2025 10:42:30 AM	2/12/2025 10:42 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1427075134	9/18/2024 4:36 PM
Medicaid Billing	NPI: State	Insert	Change Request		UT	9/18/2024 4:36 PM
Details	Last Recertification Date	Update	Recertification	1/30/2023 11:23:27 AM	1/29/2024 5:02:34 PM	1/29/2024 5:02 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1043993595 (UT)		1/4/2024 4:23 PM
Addresses	Main Address	Update	Change Request	910 EAST 100 NORTH, SUITE 155 PAYSON, UT 84651	285 N 1250 E Ste 103 PAYSON, UT 84651	10/26/2023 5:43 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1043993595	10/26/2023 5:43 PM
Medicaid Billing	NPI: State	Insert	Change Request		UT	10/26/2023 5:43 PM
Details	Entity Subname	Update	Change Request	PAYSON FAMILY HEALTH CENTER	Mountainlands Community Health Center - Payson 2	10/26/2023 5:43 PM
Details	Last Recertification Date	Update	Recertification	2/1/2022 4:36:06 PM	1/30/2023 11:23:27 AM	1/30/2023 11:23 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1437364882 (UT)		8/9/2022 12:50 PM
Contacts	Primary Contact	Update	Change Request	Morrow, Kellie Operations Director Mountainlands Community Health Center 8014292000-1153	Yorgason, Ronda Director of Operations Mountainlands Community Health Center 8018550153	2/7/2022 4:33 PM
Details	Last Recertification Date	Update	Recertification	2/1/2021 5:09:19 PM	2/1/2022 4:36:06 PM	2/1/2022 4:36 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1437364882 ( )		2/1/2021 5:09 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1437364882	2/1/2021 5:09 PM
Medicaid Billing	NPI: State	Insert	Recertification		UT	2/1/2021 5:09 PM
Details	Last Recertification Date	Update	Recertification	1/27/2020 5:01:29 PM	2/1/2021 5:09:19 PM	2/1/2021 5:09 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	7/27/2020 5:16 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1437364882	7/27/2020 5:16 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		UT	7/27/2020 5:16 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1437364882	7/27/2020 5:16 PM
Details	Last Recertification Date	Update	Recertification	1/28/2019 6:48:26 PM	1/27/2020 5:01:29 PM	1/27/2020 5:01 PM
Details	Last Recertification Date	Update	Recertification	2/7/2018 5:37:21 PM	1/28/2019 6:48:26 PM	1/28/2019 6:48 PM
Contacts	Primary Contact	Update	Recertification	Bailey, Todd Executive Director Mountainlands Community Health Center, Inc. 8014292000-1155	Morrow, Kellie Operations Director Mountainlands Community Health Center 8014292000-1153	2/7/2018 5:37 PM
Details	Last Recertification Date	Update	Recertification	1/26/2017 12:00:00 AM	2/7/2018 5:37:21 PM	2/7/2018 5:37 PM
Contacts	Authorizing Official	Update		Bailey, Todd Executive Director 8014292000-1155	Bailey, Todd Executive Director Mountainlands Community Health Center, Inc. 8014292000-1155	9/19/2017 4:59 PM
Contacts	Primary Contact	Update		Bailey, Todd Executive Director 8014292000-1155	Bailey, Todd Executive Director Mountainlands Community Health Center, Inc. 8014292000-1155	9/19/2017 4:59 PM
Addresses	Main Address	Insert			910 EAST 100 NORTH, SUITE 155 PAYSON, UT 84651	1/26/2017 3:15 PM
Contacts	Authorizing Official	Insert			Bailey, Todd Executive Director 8014292000-1155	1/26/2017 3:15 PM
Contacts	Primary Contact	Insert			Bailey, Todd Executive Director 8014292000-1155	1/26/2017 3:15 PM
Details	Last Recertification Date	Update		2/16/2016 12:00:00 AM	1/26/2017 12:00:00 AM	1/26/2017 3:14 PM
Details	Last Recertification Date	Update		2/10/2015 12:00:00 AM	2/16/2016 12:00:00 AM	2/16/2016 12:46 PM
Details	Last Recertification Date	Update		2/11/2014 12:00:00 AM	2/10/2015 12:00:00 AM	2/10/2015 3:47 PM
Details	Last Recertification Date	Update		4/1/2013 12:00:00 AM	2/11/2014 12:00:00 AM	2/11/2014 1:19 PM
Details	Last Recertification Date	Update			4/1/2013 12:00:00 AM	2/14/2013 3:09 PM
Details	Last Recertification Date	Insert				9/3/2010 10:58 AM
Details	Grant Number	Insert			H80CS00213	9/3/2010 10:58 AM
Details	340B ID	Insert			CH08395A	9/3/2010 10:58 AM
Details	Is Authorizing Official EHB Data	Insert				9/3/2010 10:58 AM
Dates	Last Date That 340B Drugs Purchased	Insert				9/3/2010 10:58 AM
Details	Medicare Provider Number	Insert				9/3/2010 10:58 AM
Details	Entity Name	Insert			MOUNTAINLANDS COMMUNITY HEALTH CENTER	9/3/2010 10:58 AM
Details	Program Code	Insert			CH	9/3/2010 10:58 AM
Details	Entity Subname	Insert			PAYSON FAMILY HEALTH CENTER	9/3/2010 10:58 AM
Dates	Participating Approval Date	Insert			8/26/2005 12:00:00 AM	9/3/2010 10:58 AM
Details	State	Insert			Active	9/3/2010 10:58 AM
Dates	Registration Date	Insert			8/22/2005 12:00:00 AM	9/3/2010 10:58 AM
Dates	Signed By Date	Insert			8/10/2005 12:00:00 AM	9/3/2010 10:58 AM
Dates	Start Date	Insert			9/9/2005 12:00:00 AM	9/3/2010 10:58 AM
Terminations	Termination Comments	Insert				9/3/2010 10:58 AM
Terminations	Termination Date	Insert				9/3/2010 10:58 AM
Terminations	Termination Effective Date	Insert				9/3/2010 10:58 AM
Terminations	Termination Reason	Insert				9/3/2010 10:58 AM

340B Drug Pricing Program Database