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SMITH'S PHARMACY #94
CH083950 MOUNTAINLANDS COMMUNITY HEALTH CENTER, INC
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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
SMITH'S PHARMACY #94
Pharmacy Address
455 SOUTH 500 EAST
SALT LAKE CITY, UT 84102
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
7/7/2020
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
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