340B Drug Pricing Program Database
WAL-MART PHARMACY 10-5997
CH037030 Mary's Center For Maternal And Child Care, Inc. - information as of 5/12/2025 10:29:04 PM
Covered Entity Details
Entity Name
Mary's Center For Maternal And Child Care, Inc.
Subdivision Name
Adams Morgan DC
Type
HRSA-Funded Health Center
340B ID
CH037030
Entity Address
2333 Ontario Rd NW
Washington, DC 20009-2627
Grant Number
H80CS04202
Participating Start Date
7/1/2014
Last Recertification Date
2/27/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5997
Pharmacy Address
9600 PARKSOUTH CT. SUITE 100
ORLANDO, FL 32837
Pharmacy Comments
Contract Details
Approval Date
7/12/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Dara Koppelman, EVP of Health Services and Programs
(202) 545-2063
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
7/12/2021
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