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WALGREEN CO.
CH08126D Mountain Family Health Centers
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Covered Entity Details
Entity Name
Mountain Family Health Centers
Subdivision Name
Mountain Family Health Centers Basalt
Type
HRSA-Funded Health Center
340B ID
CH08126D
Entity Address
123 Emma Rd, Ste 106
Basalt, CO 81621-9169
Grant Number
H80CS00830
Participating Start Date
10/1/2011
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #15101
15 SUN ROAD
P.O. BOX 8438
AVON, CO 81620
Pharmacy Comments
Contract Details
Approval Date
3/2/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Art M Fernandez, Chief Operating Officer
(970) 945-2840 Ext: 7205
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
3/2/2018
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