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WAL-MART PHARMACY 10-5232
CH081260E Mountain Family Health Centers
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Covered Entity Details
Entity Name
Mountain Family Health Centers
Subdivision Name
Mountain Family Health Centers Rifle
Type
HRSA-Funded Health Center
340B ID
CH081260E
Entity Address
195 W. 14th St., Bldg C
Rifle, CO 81650-4717
Grant Number
H80CS00830
Participating Start Date
10/1/2011
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5232
Pharmacy Address
1000 AIRPORT RD
RIFLE, CO 81650
Pharmacy Comments
Contract Details
Approval Date
5/7/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ross Brooks, CEO
(970) 945-2840
Contract Pharmacy Representative
Lori Williams, Pharmacy Manager
(970) 625-7403
Signed By Date
5/7/2015
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