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SMITH'S PHARMACY #87
CHC26644-00 Utah Partners for Health
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Covered Entity Details
Entity Name
Utah Partners for Health
Subdivision Name
Mid-Valley Health Clinic
Type
HRSA-Funded Health Center
340B ID
CHC26644-00
Entity Address
8446 S Harrison St
Midvale, UT 84047-3501
Grant Number
H80CS26644
Participating Start Date
7/1/2014
Last Recertification Date
2/28/2025
Pharmacy Details
Pharmacy Name
SMITH'S PHARMACY #87
Pharmacy Address
442 N 175 E
LOGAN, UT 84321
Pharmacy Comments
12/17/2012 address update (was 175 EAST 442 NORTH)
Contract Details
Approval Date
1/11/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kurt Micka, Executive Director
(801) 417-0131 Ext: 101
Contract Pharmacy Representative
Smiths Food & Drug Centers
Blair Woolf, Pharmacy Director
(801) 974-1302
Signed By Date
1/11/2016
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