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GREYBULL DRUG, LLC
CHC24102-12 BIGHORN VALLEY HEALTH CENTER INC
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Covered Entity Details
Entity Name
BIGHORN VALLEY HEALTH CENTER INC
Subdivision Name
One Health - Greybull
Type
HRSA-Funded Health Center
340B ID
CHC24102-12
Entity Address
444 Greybull Ave
Greybull, WY 82426-2037
Grant Number
H80CS24102
Participating Start Date
12/8/2022
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
GREYBULL DRUG, LLC
Pharmacy Address
925 N. 6TH ST
GREYBULL, WY 82426
Pharmacy Comments
Contract Details
Approval Date
4/15/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
David A. Mark, Chief Executive Officer
(406) 665-4103
Contract Pharmacy Representative
greybull drug
Ross Davidson, PIC
(307) 765-4601
Signed By Date
4/15/2024
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