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WAL-MART PHARMACY 10-3083
CH08146AZ Peak Vista Community Health Centers
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Covered Entity Details
Entity Name
Peak Vista Community Health Centers
Subdivision Name
Developmental Disabilities Health Center
Type
HRSA-Funded Health Center
340B ID
CH08146AZ
Entity Address
3205 N. Academy Blvd. STE 120
Colorado Springs, CO 80917
Grant Number
H80CS00212
Participating Start Date
10/1/2023
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-3083
Pharmacy Address
665 N MURRAY BLVD
COLORADO SPRINGS, CO 80915-3405
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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