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POWELL DRUG
CHC24102-10 BIGHORN VALLEY HEALTH CENTER INC
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Covered Entity Details
Entity Name
BIGHORN VALLEY HEALTH CENTER INC
Subdivision Name
One Health - Powell
Type
HRSA-Funded Health Center
340B ID
CHC24102-10
Entity Address
1201 E 7th St
Powell, WY 82435
Grant Number
H80CS24102
Participating Start Date
12/8/2022
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
POWELL DRUG
Pharmacy Address
140 N BENT ST
POWELL, WY 82435
Pharmacy Comments
Contract Details
Approval Date
10/15/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
David A. Mark, Chief Executive Officer
(406) 665-4103
Contract Pharmacy Representative
Powell Drug
David Klingler, Pharmacist
(307) 754-2031
Signed By Date
10/15/2023
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