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WAL-MART PHARMACY 10-5997
CH080730 METRO COMMUNITY PROVIDER NETWORK, INC.
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Covered Entity Details
Entity Name
METRO COMMUNITY PROVIDER NETWORK, INC.
Subdivision Name
STRIDE CHC- Peoria
Type
HRSA-Funded Health Center
340B ID
CH080730
Entity Address
3292 Peoria St
Aurora, CO 80010
Grant Number
H80CS00217
Participating Start Date
12/1/1992
Last Recertification Date
2/21/2025
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
1/9/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ben Wiederholt, CEO
(303) 761-1977 Ext: 1103
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
1/9/2019
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