Pharmacy Details

WALMART PHARMACY 10-6964 - information as of 4/29/2025 1:59:11 AM

Name
WALMART PHARMACY 10-6964

Address

4150 GOODMAN ROAD WEST
HORN LAKE, MS 38637

Comments

Contracts
History

Contracts

Contract Detail	340B ID	Entity Name	Sub Name	Entity Type	Address	Address Cont.	City	State	Begin Date	Term Date	Edit Date
Details	CH043060	NORTHEAST MISSISSIPPI HEALTH CARE, INC.	DBA BYHALIA FAMILY HEALTH CENTER	HRSA-Funded Health Center	12 BRUNSWICK ST		BYHALIA	MS	07/01/2024		7/1/2024 12:01 AM
Details	RWII37917	Positively Living, Inc.		Ryan White Part B	1925 Ailor Ave		Knoxville	TN	01/01/2020	05/31/2023	7/19/2023 9:19 AM

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Addresses	Pharmacy Address	Insert			WALMART PHARMACY 10-6964 4150 GOODMAN ROAD WEST HORN LAKE, MS 38637	9/29/2017 6:44 AM
Details	Comments	Insert				11/6/2015 4:04 PM
Details	Is Deleted	Insert			False	11/6/2015 4:04 PM
Addresses	Pharmacy Address	Insert			WALMART PHARMACY 10-6964 4150 GOODMAN ROAD WEST HORN LAKE, MS 38637	11/6/2015 4:04 PM
Details	Name	Insert			WALMART PHARMACY 10-6964	11/6/2015 4:04 PM