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WILLOW CREEK HEALTH MART
CH084100 HIGH PLAINS COMMUNITY HEALTH CENTER
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Covered Entity Details
Entity Name
HIGH PLAINS COMMUNITY HEALTH CENTER
Subdivision Name
HIGH PLAINS COMMUNITY HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH084100
Entity Address
201 Kendall Dr
Lamar, CO 81052-3939
Grant Number
H80CS00214
Participating Start Date
7/1/1997
Last Recertification Date
2/25/2025
Pharmacy Details
Pharmacy Name
WILLOW CREEK HEALTH MART
Pharmacy Address
1700 S MAIN ST
LAMAR, CO 81052-3827
Pharmacy Comments
Contract Details
Approval Date
10/16/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ERIC NIEMEYER, CEO
(719) 336-0261 Ext: 120
Contract Pharmacy Representative
Willow Creek Health Mart Pharmacy
Tom Davis, President
(719) 456-1691
Signed By Date
10/16/2017
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