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SMITHS FOOD & DRUG CTRS
CH08395E MOUNTAINLANDS COMMUNITY HEALTH CENTER, INC
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Covered Entity Details
Entity Name
MOUNTAINLANDS COMMUNITY HEALTH CENTER, INC
Subdivision Name
East Bay Health Center
Type
HRSA-Funded Health Center
340B ID
CH08395E
Entity Address
299 East 900 South, Suite 101
Provo, UT 84606-6107
Grant Number
H80CS00213
Participating Start Date
1/1/2016
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
SMITHS FOOD & DRUG CTRS
Pharmacy Address
DBA SMITH'S FOOD & DRUG #136
350 NORTH FREEDOM BOULEVARD
PROVO, UT 84601
Pharmacy Comments
Contract Details
Approval Date
1/3/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/16/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Todd Bailey, Executive Director
(801) 429-2000 Ext: 1155
Contract Pharmacy Representative
Kroger health
Dana Bach, Contract Manager
(513) 562-5299
Signed By Date
1/3/2023
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