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WAL-MART PHARMACY 10-5957
CH081460 PEAK VISTA COMMUNITY HEALTH CENTERS
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Covered Entity Details
Entity Name
PEAK VISTA COMMUNITY HEALTH CENTERS
Subdivision Name
Peak Vista Administrative Services Center
Type
HRSA-Funded Health Center
340B ID
CH081460
Entity Address
3205 N Academy Blvd Ste 130
Colorado Springs, CO 80917
Grant Number
H80CS00212
Participating Start Date
12/1/1992
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5957
Pharmacy Address
5957 WEST 44TH AVE
DENVER, CO 80212-7410
Pharmacy Comments
Contract Details
Approval Date
7/17/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/22/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
PAMELA J. MCMANUS, PRESIDENT AND CEO
(719) 344-6453
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
7/17/2017
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