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CH08126P MOUNTAIN FAMILY HEALTH CENTERS (Terminated)
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Main Details
Name
MOUNTAIN FAMILY HEALTH CENTERS
Subdivision Name
MOUNTAIN FAMILY HEALTH CENTERS DENTAL VAN.
Type
HRSA-Funded Health Center
Site ID
BPS-H80-019590
340B ID
CH08126P
Grant Number
H80CS00830
Additional Details
Current Program Status
Terminated
Registration Date
1/17/2023
Participating Start Date
4/1/2023
Participating Approval Date
1/18/2023
Last Recertification Date
Termination Date
Termination Reason
7/1/2023
Other
Contacts
Authorizing Official
Mountain Family Health Centers
Rachel Illias, Pharmacy Director
(970) 945-2840 Ext: 7230
Primary Contact
Mountain Family Health Centers
Jackie Marie Marshall, Compliance Coordinator
(970) 945-2840 Ext: 7212
Addresses
Street Address
1905 Blake Ave STE 101
Glenwood Springs, CO 81601-4206
Billing Address
Mountain Family Health Centers
PO Box 339
Glenwood Springs, CO 81601
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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