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SMITH'S PHARMACY #28
CHC26644-01 Utah Partners for Health
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Covered Entity Details
Entity Name
Utah Partners for Health
Subdivision Name
Utah Partners for Health Mobile Clinic
Type
HRSA-Funded Health Center
340B ID
CHC26644-01
Entity Address
8446 S Harrison St
Midvale, UT 84047-3501
Grant Number
H80CS26644
Participating Start Date
7/1/2014
Last Recertification Date
2/28/2025
Pharmacy Details
Pharmacy Name
SMITH'S PHARMACY #28
Pharmacy Address
922 E. 2100 S.
SALT LAKE CITY, UT 84106
Pharmacy Comments
Contract Details
Approval Date
10/3/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kurt Micka, Executive Director
(801) 417-0131 Ext: 101
Contract Pharmacy Representative
Smiths Food & Drug
Jaime Montuoro, Pharmacy Director
(801) 974-1340
Signed By Date
10/3/2018
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