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POWELL DRUG, INC.
CHC28358-00 POWELL HEALTH CARE COALITION
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Covered Entity Details
Entity Name
POWELL HEALTH CARE COALITION
Subdivision Name
Heritage Health Center
Type
HRSA-Funded Health Center
340B ID
CHC28358-00
Entity Address
128 N BENT ST
POWELL, WY 82435-2712
Grant Number
H80CS28358
Participating Start Date
7/1/2016
Last Recertification Date
2/24/2022
Entity Termination Date
4/1/2023
Pharmacy Details
Pharmacy Name
POWELL DRUG, INC.
Pharmacy Address
140 N BENT PO BOX 191
POWELL, WY 82435-0191
Pharmacy Comments
Contract Details
Approval Date
4/18/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/1/2018
Ownership change
Contacts
Covered Entity Signing Official
Julie Mann, Billing Service Manager
(307) 764-1602
Contract Pharmacy Representative
Steve Rogers, President
(307) 754-2031
Signed By Date
4/18/2016
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