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WAL-MART PHARMACY 10-5997
CH0452880 TRIAD HEALTH SYSTEM INC
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Covered Entity Details
Entity Name
TRIAD HEALTH SYSTEM INC
Subdivision Name
TRIAD HEALTH SYSTEMS CHC
Type
HRSA-Funded Health Center
340B ID
CH0452880
Entity Address
441 US Highway 42 West
Warsaw, KY 41095-9323
Grant Number
H80CS08785
Participating Start Date
7/1/2008
Last Recertification Date
2/25/2025
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
10/10/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ADAM CRAFT, EXECUTIVE DIRECTOR
(859) 567-1271
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
10/10/2018
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