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WESTERN PHARMACY GROUP LLC
CH08126G MOUNTAIN FAMILY HEALTH CENTERS
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Covered Entity Details
Entity Name
MOUNTAIN FAMILY HEALTH CENTERS
Subdivision Name
MOUNTAIN FAMILY HEALTH CENTERS AVON SCHOOL-BASED HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH08126G
Entity Address
0850 West Beaver Creek Blvd
Avon, CO 81620
Grant Number
H80CS00830
Participating Start Date
1/1/2017
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WESTERN PHARMACY GROUP LLC
Pharmacy Address
DBA COMMUNITY MEDICAL CENTER PHARMACY
610 GATEWAY CENTER WAY
SUITES A--E
SAN DIEGO, CA 92102
Pharmacy Comments
Contract Details
Approval Date
6/4/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/11/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Art M Fernandez, Chief Operating Officer
(970) 945-2840 Ext: 7205
Contract Pharmacy Representative
Western Pharmacy Group LLC
KEVIN FARIS, CEO
(360) 685-4263
Signed By Date
6/4/2018
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