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CITY MARKET PHARMACY #22
CH080030 VALLEY-WIDE HEALTH SYSTEMS, INC.
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Covered Entity Details
Entity Name
VALLEY-WIDE HEALTH SYSTEMS, INC.
Subdivision Name
Alamosa Family Medical Center, Valley Wide Pharmacy, or Anti-Coagulation Clinic
Type
HRSA-Funded Health Center
340B ID
CH080030
Entity Address
1710 1st St
Alamosa, CO 81101
Grant Number
H80CS00134
Participating Start Date
12/1/1992
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
CITY MARKET PHARMACY #22
Pharmacy Address
131 MARKET ST
ALAMOSA, CO 81101
Pharmacy Comments
09/12/2013 - Deleted duplicate Pharmacy per OPA instructions.
Contract Details
Approval Date
4/20/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
JEANNE DARRICADES, PRESIDENT/CEO
(719) 589-5161
Contract Pharmacy Representative
Signed By Date
4/20/2015
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