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WAL-MART PHARMACY 10-5997
CH032960 WESTSIDE FAMILY HEALTHCARE, INC.
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Covered Entity Details
Entity Name
WESTSIDE FAMILY HEALTHCARE, INC.
Subdivision Name
Westside Family Healthcare - Administration Office
Type
HRSA-Funded Health Center
340B ID
CH032960
Entity Address
300 Water Street
Suite 200
Wilmington, DE 19801-5043
Grant Number
H80CS00789
Participating Start Date
4/1/2000
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
7/25/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
LOLITA A. LOPEZ, PRESIDENT AND CEO
(302) 656-8292
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
7/25/2017
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