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WAL-MART PHARMACY 10-5123
CH08146AX Peak Vista Community Health Centers
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Covered Entity Details
Entity Name
Peak Vista Community Health Centers
Subdivision Name
Springs Rescue Mission- Health Center 2
Type
HRSA-Funded Health Center
340B ID
CH08146AX
Entity Address
5 W Las Vegas St Rm 211
Colorado Springs, CO 80903
Grant Number
H80CS00212
Participating Start Date
4/1/2021
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5123
Pharmacy Address
5550 EAST WOODMEN ROAD
COLORADO SPRINGS(NE), CO 80920
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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