Contract Pharmacy Details

SMITHS FOOD & DRUG CTRS
CH083950 MOUNTAINLANDS COMMUNITY HEALTH CENTER, INC

Covered Entity Details

Entity Name

MOUNTAINLANDS COMMUNITY HEALTH CENTER, INC

Subdivision Name

Mountainlands Community Health Center Main Site Clinic

Type

HRSA-Funded Health Center

340B ID

CH083950

Entity Address

589 S. State Street
Provo, UT 84606-5056

Grant Number

H80CS00213

Participating Start Date

7/1/1995

Last Recertification Date

2/12/2025

Pharmacy Details

Pharmacy Name

SMITHS FOOD & DRUG CTRS

Pharmacy Address

SMITH'S DRUG KING PHARMACY #75
632 SOUTH 100 WEST
PAYSON, UT 84651

Pharmacy Comments

Contract Details

Approval Date

1/6/2016

Contract Begin Date

4/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/16/2024
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Todd Bailey, Executive Director
(801) 429-2000 Ext: 1155

Contract Pharmacy Representative

Smiths Food & Drug Centers
Blair Woolf, Pharmacy Director
(801) 974-1302

Signed By Date

1/6/2016

340B Drug Pricing Program Database