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POWELL DRUG
CHC28358-00 POWELL HEALTH CARE COALITION
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Covered Entity Details
Entity Name
POWELL HEALTH CARE COALITION
Subdivision Name
Heritage Health Center
Type
HRSA-Funded Health Center
340B ID
CHC28358-00
Entity Address
128 N BENT ST
POWELL, WY 82435-2712
Grant Number
H80CS28358
Participating Start Date
7/1/2016
Last Recertification Date
2/24/2022
Entity Termination Date
4/1/2023
Pharmacy Details
Pharmacy Name
POWELL DRUG
Pharmacy Address
140 N BENT ST
POWELL, WY 82435
Pharmacy Comments
Contract Details
Approval Date
10/12/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Colette Rene Mild, Chief Executive Officer
(307) 764-1601
Contract Pharmacy Representative
PHARMACISTS IMPROVING LIVES, INC. DBA Powell Drug
David W. Klingler, Owner
(307) 754-2031
Signed By Date
10/12/2018
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