Contract Pharmacy Details

VILAS PHARMACY
CHC00349-01 PRAIRIE COMMUNITY HEALTH INC

Covered Entity Details

Entity Name

PRAIRIE COMMUNITY HEALTH INC

Subdivision Name

Family Health Center of Eagle Butte

Type

HRSA-Funded Health Center

340B ID

CHC00349-01

Entity Address

North Hwy 212
Eagle Butte, SD 57625

Grant Number

H80CS00349

Participating Start Date

10/1/2009

Last Recertification Date

3/3/2016

Entity Termination Date

7/1/2016

Pharmacy Details

Pharmacy Name

VILAS PHARMACY

Pharmacy Address

223 S MAIN ST
EAGLE BUTTE, SD 57625

Pharmacy Comments

Contract Details

Approval Date

9/8/2010

Contract Begin Date

9/8/2010

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/16/2016
Covered Entity Terminated

Contacts

Covered Entity Signing Official

PAM LOCKEN, CEO
(605) 466-2120

Contract Pharmacy Representative

JAMES STEPHENS, OWNER/PHARMACIST
(605) 222-2988

Signed By Date

8/18/2010