340B Drug Pricing Program Database
Walmart Pharmacy 10-7611
CH048980 LEWIS COUNTY PRIMARY CARE CENTER, INC. - information as of 4/28/2025 1:04:58 AM
Covered Entity Details
Entity Name
LEWIS COUNTY PRIMARY CARE CENTER, INC.
Subdivision Name
Lewis County Primary Care Center, Inc.
Type
HRSA-Funded Health Center
340B ID
CH048980
Entity Address
211 KY 59
Building A
VANCEBURG, KY 41179
Grant Number
H80CS00106
Participating Start Date
1/1/1999
Last Recertification Date
2/26/2025
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
4/12/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
JERRY UGRIN, CEO
(606) 796-3029
Contract Pharmacy Representative
Walmart
Van Donn, Director of Contracting 340b
(303) 261-5549
Signed By Date
4/12/2024
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