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MOUNTAIN CITY PHARMACY
CHC24142-11 High Country Community Health
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Covered Entity Details
Entity Name
High Country Community Health
Subdivision Name
High Country Community Health Primedical
Type
HRSA-Funded Health Center
340B ID
CHC24142-11
Entity Address
240 Highway 105 Ext
Suite 100
Boone, NC 28607-4948
Grant Number
H80CS24142
Participating Start Date
4/1/2022
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
MOUNTAIN CITY PHARMACY
Pharmacy Address
1641 S SHADY ST
MOUNTAIN CITY, TN 37683
Pharmacy Comments
Contract Details
Approval Date
1/13/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Alice Salthouse, CEO
(828) 262-3886 Ext: 127
Contract Pharmacy Representative
Mountain City Pharmacy
Corey Furman, President
(423) 727-0038
Signed By Date
1/13/2022
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