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WAL-MART PHARMACY 10-0152
CHC24105-06 COMMUNITY TREATMENT INCORPORATED
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Covered Entity Details
Entity Name
COMMUNITY TREATMENT INCORPORATED
Subdivision Name
Community Treatment, Inc - South
Type
HRSA-Funded Health Center
340B ID
CHC24105-06
Entity Address
110 N. Mill St.
Festus, MO 63028-1816
Grant Number
H80CS24105
Participating Start Date
1/1/2015
Last Recertification Date
1/30/2023
Entity Termination Date
1/1/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0152
Pharmacy Address
12862 STATE ROAD 21
DE SOTO, MO 63020
Pharmacy Comments
Contract Details
Approval Date
7/16/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Amy Rhodes, CFO
(636) 232-2341
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
7/16/2018
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