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POLE MOUNTAIN PHARMACY
CHC330723-02 University of Wyoming
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Covered Entity Details
Entity Name
University of Wyoming
Subdivision Name
Albany Community Health Clinic
Type
HRSA-Funded Health Center
340B ID
CHC330723-02
Entity Address
2710 E. HARNEY STREET STE 202-204
Laramie, WY 82072-5401
Grant Number
H80CS30723
Participating Start Date
7/1/2019
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
POLE MOUNTAIN PHARMACY
Pharmacy Address
319 E HARNEY ST
LARAMIE, WY 82072-2523
Pharmacy Comments
Contract Details
Approval Date
1/15/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Diana Grant Hulme, Associate Vice President Research
(307) 766-6811
Contract Pharmacy Representative
Pole Mountain Pharmacy
Brett Kvenlid, Primary Contact
(307) 460-4080
Signed By Date
1/15/2021
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