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SMITH'S PHARMACY
DSH460009 University of Utah
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Covered Entity Details
Entity Name
University of Utah
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH460009
Entity Address
50 North Medical Drive
Salt Lake City, UT 84132
Medicare Provider Number
460009
Participating Start Date
7/1/1996
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
SMITH'S PHARMACY
Pharmacy Address
SMITH'S FOOD & DRUG #42
633 S. MAIN
CEDAR CITY, UT 84720
Pharmacy Comments
Contract Details
Approval Date
7/13/2020
Contract Begin Date
8/28/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/31/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Gordon Crabtree, CEO
(801) 587-3572
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
7/13/2020
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