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CITY MARKET PHARMACY #451
CAH061302-00 Lower Valley Hospital Association d/b/a/ Family Health West Hospital
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Covered Entity Details
Entity Name
Lower Valley Hospital Association d/b/a/ Family Health West Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH061302-00
Entity Address
Family Health West Hospital
300 West Ottley Ave
Fruita, CO 81521
Medicare Provider Number
061302
Participating Start Date
4/1/2014
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
CITY MARKET PHARMACY #451
Pharmacy Address
630 24 ROAD
GRAND JUNCTION, CO 81505
Pharmacy Comments
Contract Details
Approval Date
10/8/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/12/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Mark J. Francis, CEO
(970) 858-2106
Contract Pharmacy Representative
Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672
Signed By Date
10/8/2015
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