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WAL-MART PHARMACY 10-3331
RW400106B JEFFERSON COMPREHENSIVE CARE SYSTEM INC
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Covered Entity Details
Entity Name
JEFFERSON COMPREHENSIVE CARE SYSTEM INC
Subdivision Name
ALTHEIMER CENTER
Type
Ryan White Part D
340B ID
RW400106B
Entity Address
309 S EDLINE
ALTHEIMER, AR 72004
Grant Number
H12HA00106
Participating Start Date
1/1/2007
Last Recertification Date
2/23/2018
Entity Termination Date
4/1/2019
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-3331
Pharmacy Address
5501 SOUTH OLIVE ST
PINE BLUFF, AR 71603
Pharmacy Comments
Contract Details
Approval Date
10/15/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Sandra J. Brown, Chief Executive Officer
(870) 543-2300
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/15/2018
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