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SUPER DRUG AND HERBAL STORE
CAH461306-00 GUNNISON VALLEY HOSPITAL
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Covered Entity Details
Entity Name
GUNNISON VALLEY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH461306-00
Entity Address
64 E 100 N
GUNNISON, UT 84634-0759
Medicare Provider Number
461306
Participating Start Date
9/30/2010
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
SUPER DRUG AND HERBAL STORE
Pharmacy Address
520 SOUTH HWY 89
P.O. BOX 716
GUNNISON, UT 84634-0716
Pharmacy Comments
Contract Details
Approval Date
5/11/2012
Contract Begin Date
5/11/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
BRIAN C. MURRAY, CFO
(435) 528-2146
Contract Pharmacy Representative
Len Fitzgerald, Owner/President
(435) 528-7555
Signed By Date
4/26/2012
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