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SMITHS FOOD & DRUG CTR INC
CH082490 GREEN RIVER MEDICAL CENTER
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Covered Entity Details
Entity Name
GREEN RIVER MEDICAL CENTER
Subdivision Name
GREEN RIVER MEDICAL CENTER
Type
HRSA-Funded Health Center
340B ID
CH082490
Entity Address
585 WEST MAIN STREET
GREEN RIVER, UT 84525-0417
Grant Number
H80CS00462
Participating Start Date
7/1/2003
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
SMITHS FOOD & DRUG CTR INC
Pharmacy Address
SMITH'S PHARMACY #147
5620 W 4100 SO
WEST VALLEY CITY, UT 84128
Pharmacy Comments
Contract Details
Approval Date
1/12/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/31/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Paula Dunham, Executive Director
(435) 564-0213
Contract Pharmacy Representative
Smiths Food & Drug Centers
Blair Woolf, Pharmacy Director
(801) 974-1302
Signed By Date
1/12/2018
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