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WAL-MART PHARMACY 10-3589
CH08380F Midtown Community Health Center, Inc.
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Covered Entity Details
Entity Name
Midtown Community Health Center, Inc.
Subdivision Name
Midtown Community Health Center South Salt Lake
Type
HRSA-Funded Health Center
340B ID
CH08380F
Entity Address
60 E 3750 S
Salt Lake City, UT 84115-2752
Grant Number
H80CS00831
Participating Start Date
4/1/2014
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-3589
Pharmacy Address
350 WEST HOPE AVE
SALT LAKE CITY, UT 84115
Pharmacy Comments
Contract Details
Approval Date
4/10/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/27/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Alicia Martinez, Chief Executive Officer
(801) 334-1321
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/10/2020
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