Contract Pharmacy Details

SMITH'S PHARMACY #444
CH083800 Midtown Community Health Center, Inc.

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 #444

Pharmacy Address

555 S. 200 W.
BOUNTIFUL, UT 84010

Pharmacy Comments

Contract Details

Approval Date

4/13/2016

Contract Begin Date

7/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

6/29/2021
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Alicia Martinez, Chief Executive Officer
(801) 334-1321

Contract Pharmacy Representative

Smiths Food & Drug Centers
Blair Woolf, Pharmacy Director
(801) 974-1302

Signed By Date

4/13/2016

340B Drug Pricing Program Database