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WAL-MART PHARMACY 10-3792
CHC12890-04 FAIRFIELD COMMUNITY HEALTH CENTER
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Covered Entity Details
Entity Name
FAIRFIELD COMMUNITY HEALTH CENTER
Subdivision Name
Fairfield Community Health Center - Baltimore
Type
HRSA-Funded Health Center
340B ID
CHC12890-04
Entity Address
1055 W Market St STE H
Baltimore, OH 43105-1284
Grant Number
H80CS19595
Participating Start Date
1/1/2012
Last Recertification Date
1/30/2023
Entity Termination Date
10/1/2023
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-3792
Pharmacy Address
2687 NORTH MEMORIAL DRIVE
LANCASTER, OH 43130
Pharmacy Comments
Contract Details
Approval Date
10/11/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Lauree Althaus, Director of Finance
(740) 277-6043 Ext: 1001
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
10/11/2018
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