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GUNNISON VALLEY HOSPITAL- MANTI PHARMACY
CAH461306-00 GUNNISON VALLEY HOSPITAL
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Covered Entity Details
Entity Name
GUNNISON VALLEY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH461306-00
Entity Address
64 E 100 N
GUNNISON, UT 84634-0759
Medicare Provider Number
461306
Participating Start Date
9/30/2010
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
GUNNISON VALLEY HOSPITAL- MANTI PHARMACY
Pharmacy Address
156 S MAIN ST
MANTI, UT 84642
Pharmacy Comments
Contract Details
Approval Date
1/2/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
BRIAN C. MURRAY, CFO
(435) 528-2146
Contract Pharmacy Representative
Gunnison Valley Hospital
Michael McQuivey, Pharmacist
(435) 835-7250
Signed By Date
1/2/2024
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