Contract Pharmacy Details

SMITH'S PHARMACY #94
CH08022P COMMUNITY HEALTH CENTERS, INC.

Covered Entity Details

Entity Name

COMMUNITY HEALTH CENTERS, INC.

Subdivision Name

Community Health Centers, Inc - Liberty Community Learning Center

Type

HRSA-Funded Health Center

340B ID

CH08022P

Entity Address

1078 S 300 E #4
Salt Lake City, UT 84111

Grant Number

H80CS00220

Participating Start Date

10/3/2017

Last Recertification Date

1/28/2019

Entity Termination Date

4/1/2020

Pharmacy Details

Pharmacy Name

SMITH'S PHARMACY #94

Pharmacy Address

455 SOUTH 500 EAST
SALT LAKE CITY, UT 84102

Pharmacy Comments

Contract Details

Approval Date

10/3/2017

Contract Begin Date

10/3/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2020
Covered Entity Terminated

Contacts

Covered Entity Signing Official

DEXTER PEARCE, Executive Director
(801) 412-6920

Contract Pharmacy Representative

SFDC
Julie Arellano, Third Party Insurance Coordinator
(801) 974-1402

Signed By Date

10/3/2017

340B Drug Pricing Program Database