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WAL-MART PHARMACY 10-1572
CH08395D MOUNTAINLANDS COMMUNITY HEALTH CENTER, INC
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Covered Entity Details
Entity Name
MOUNTAINLANDS COMMUNITY HEALTH CENTER, INC
Subdivision Name
Mountainlands Family Health Center Vernal Dental Clinic
Type
HRSA-Funded Health Center
340B ID
CH08395D
Entity Address
133 S 500 E
VERNAL, UT 84078-2728
Grant Number
H80CS00213
Participating Start Date
1/1/2016
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1572
Pharmacy Address
1851 WEST HWY 40
VERNAL, UT 84078
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
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Todd Bailey, Executive Director
(801) 429-2000 Ext: 1155
Contract Pharmacy Representative
Walmart
Julie Howard, 340b Program Manager
(479) 739-1973 Ext: 4792771498
Signed By Date
1/3/2023
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