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WAL-MART PHARMACY 10-3435
FQHCLA361B Adult And Child Health Inc
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Covered Entity Details
Entity Name
Adult And Child Health Inc
Subdivision Name
Adult and Child Health - Greenwood
Type
Health Center Program Look-Alike
340B ID
FQHCLA361B
Entity Address
8320 Madison Ave
Indianapolis, IN 46227-6066
Grant Number
LALCS31537
Participating Start Date
1/1/2019
Last Recertification Date
2/24/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-3435
Pharmacy Address
1133 NORTH EMERSON ROAD
GREENWOOD, IN 46143
Pharmacy Comments
Contract Details
Approval Date
1/7/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Dan Arens, Chief Operating Officer
(317) 893-0336
Contract Pharmacy Representative
Adult and Child Health
Dan Arens, Chief Operating Officer
(317) 893-0336
Signed By Date
1/7/2019
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