340B Drug Pricing Program Database

Pharmacy Name

CITY MARKET PHARMACY #412

Pharmacy Address

602 N HIGLEY BLVD
RAWLINS, WY 82301-5968

Pharmacy Comments

Approval Date

7/16/2014

Contract Begin Date

10/1/2014

Carve-In Effective Date

Contract Comments

Covered Entity Signing Official

Amber Green, CCO
(307) 324-8212

Contract Pharmacy Representative

Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672

Signed By Date

7/16/2014