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MOUNTAIN CITY PHARMACY
CHC24142-00 HIGH COUNTRY COMMUNITY HEALTH
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Covered Entity Details
Entity Name
HIGH COUNTRY COMMUNITY HEALTH
Subdivision Name
High Country Community Health: Watauga Center
Type
HRSA-Funded Health Center
340B ID
CHC24142-00
Entity Address
935 State Farm Road
Boone, NC 28607
Grant Number
H80CS24142
Participating Start Date
1/1/2013
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
MOUNTAIN CITY PHARMACY
Pharmacy Address
1641 S SHADY ST
MOUNTAIN CITY, TN 37683
Pharmacy Comments
Contract Details
Approval Date
2/8/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Alice Salthouse, CEO
(828) 448-0667
Contract Pharmacy Representative
Boone Drug
John Stacy, Pharmacy Manager
(828) 264-3055
Signed By Date
1/8/2013
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