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SMITHS FOOD & DRUG CENTERS
SCH290019-00 CARSON TAHOE REGIONAL HEALTHCARE
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Covered Entity Details
Entity Name
CARSON TAHOE REGIONAL HEALTHCARE
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH290019-00
Entity Address
1600 MEDICAL PARKWAY
CARSON CITY, NV 89703
Medicare Provider Number
290019
Participating Start Date
1/1/2024
Last Recertification Date
8/14/2024
Entity Termination Date
10/1/2024
Pharmacy Details
Pharmacy Name
SMITHS FOOD & DRUG CENTERS
Pharmacy Address
SMITHS FOOD & DRUG #392
2200 HWY 50 E
DAYTON, NV 89403
Pharmacy Comments
Contract Details
Approval Date
4/15/2021
Contract Begin Date
4/21/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Mitchell Curtis Watson, Chief Financial Officer
(775) 445-5543
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
4/15/2021
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