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WAL-MART PHARMACY 10-2040
CH034140 SPECTRUM HEALTH SERVICES, INC.
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Covered Entity Details
Entity Name
SPECTRUM HEALTH SERVICES, INC.
Subdivision Name
Spectrum Community Health Center
Type
HRSA-Funded Health Center
340B ID
CH034140
Entity Address
5201 Haverford Avenue
Philadelphia, PA 19139
Grant Number
H80CS00389
Participating Start Date
1/1/2000
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2040
Pharmacy Address
2106 MT HOLLY RD
BURLINGTON, NJ 08016
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
7/8/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Stephanie Wroten, Chief Programs and Develop
(215) 471-2761 Ext: 3256
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/15/2018
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