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MOUNTAIN CITY PHARMACY
CHC24142-06 HIGH COUNTRY COMMUNITY HEALTH
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Covered Entity Details
Entity Name
HIGH COUNTRY COMMUNITY HEALTH
Subdivision Name
High Country Community Health Surry County
Type
HRSA-Funded Health Center
340B ID
CHC24142-06
Entity Address
110 Dutchman Ct
Elkin, NC 28621
Grant Number
H80CS24142
Participating Start Date
1/1/2020
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
MOUNTAIN CITY PHARMACY
Pharmacy Address
1641 S SHADY ST
MOUNTAIN CITY, TN 37683
Pharmacy Comments
Contract Details
Approval Date
4/14/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tiffany Melchers, CFO
(828) 262-3886 Ext: 120
Contract Pharmacy Representative
Mountain City Pharmacy
Corey Furman, President
(423) 727-0038
Signed By Date
4/14/2020
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