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WAL-MART PHARMACY 10-0357
CHC08748-06 COMMUNITY HEALTH CENTER OF CENTRAL MISSOURI
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Covered Entity Details
Entity Name
COMMUNITY HEALTH CENTER OF CENTRAL MISSOURI
Subdivision Name
Community Health Center of Central Missouri - Christy Drive
Type
HRSA-Funded Health Center
340B ID
CHC08748-06
Entity Address
1511 Christy Drive
Jefferson City, MO 65101-2854
Grant Number
H80CS08748
Participating Start Date
7/1/2018
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0357
Pharmacy Address
1003 WEST NEWTON ST
PO BOX 12
VERSAILLES, MO 65084
Pharmacy Comments
Contract Details
Approval Date
10/9/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Toby Barnett, CFO
(573) 632-0243
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/9/2018
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