Contract Pharmacy Details

SMITHS FOOD & DRUG CTRS
FP841024 PLANNED PARENTHOOD ASSOC. OF UTAH

Covered Entity Details

Entity Name

PLANNED PARENTHOOD ASSOC. OF UTAH

Subdivision Name

SALT LAKE CITY CLINIC

Type

Family Planning (Title X only)

340B ID

FP841024

Entity Address

654 South 900 East
SALT LAKE CITY, UT 84102

Grant Number

FPHPA006544

Participating Start Date

10/1/2022

Last Recertification Date

5/15/2024

Pharmacy Details

Pharmacy Name

SMITHS FOOD & DRUG CTRS

Pharmacy Address

DBA SMITH'S FOOD & DRUG #136
350 NORTH FREEDOM BOULEVARD
PROVO, UT 84601

Pharmacy Comments

Contract Details

Approval Date

7/17/2018

Contract Begin Date

10/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/1/2019
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Lesley Bailey, CFO
(801) 532-1586

Contract Pharmacy Representative

Smiths Food & Drug Centers
Blair Woolf, Pharmacy Director
(801) 974-1302

Signed By Date

7/17/2018

340B Drug Pricing Program Database