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WAL-MART PHARMACY 10-5997
CH071370 SOUTHEAST MISSOURI HEALTH NETWORK
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Covered Entity Details
Entity Name
SOUTHEAST MISSOURI HEALTH NETWORK
Subdivision Name
SOUTHEAST MISSOURI HEALTH NETWORK
Type
HRSA-Funded Health Center
340B ID
CH071370
Entity Address
420 SEMO DR
NEW MADRID, MO 63869-1734
Grant Number
H80CS00557
Participating Start Date
1/1/2005
Last Recertification Date
2/24/2025
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
10/18/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
CHRIS JONES, CEO
(573) 313-2501
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
10/18/2018
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