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WAL-MART PHARMACY 10-3082
CH08146R PEAK VISTA COMMUNITY HEALTH CENTERS
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Covered Entity Details
Entity Name
PEAK VISTA COMMUNITY HEALTH CENTERS
Subdivision Name
Lane Family Health Center
Type
HRSA-Funded Health Center
340B ID
CH08146R
Entity Address
4863 N. Nevada
Colorado Springs, CO 80918
Grant Number
H80CS00212
Participating Start Date
1/1/2005
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-3082
Pharmacy Address
1622 SOUTH ACADEMY BLVD
COLORADO SPRINGS, CO 80916
Pharmacy Comments
Contract Details
Approval Date
10/13/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Joel Tanaka, Chief Medical Officer
(719) 344-6530
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
10/13/2023
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