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SMITH'S PHARMACY #87
CH083800 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
Type
HRSA-Funded Health Center
340B ID
CH083800
Entity Address
2240 Adams Ave
Ogden, UT 84401-1511
Grant Number
H80CS00831
Participating Start Date
1/1/2004
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
SMITH'S PHARMACY #87
Pharmacy Address
442 N 175 E
LOGAN, UT 84321
Pharmacy Comments
12/17/2012 address update (was 175 EAST 442 NORTH)
Contract Details
Approval Date
10/7/2013
Contract Begin Date
1/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/20/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Lisa Nichols, Executive Director
(801) 710-0973
Contract Pharmacy Representative
Smiths Food & Drug Centers
Blair Woolf, Pharmacy Director
(801) 974-1302
Signed By Date
10/7/2013
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