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WAL-MART PHARMACY 10-1454
CHC26512-02 PREFERRED FAMILY HEALTHCARE, INCORPORATED
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Covered Entity Details
Entity Name
PREFERRED FAMILY HEALTHCARE, INCORPORATED
Subdivision Name
Quincy Senior and Family Resource Center
Type
HRSA-Funded Health Center
340B ID
CHC26512-02
Entity Address
639 YORK ST
QUINCY, IL 62301-3963
Grant Number
H80CS26512
Participating Start Date
4/1/2016
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1454
Pharmacy Address
5211 BROADWAY STREET
QUINCY, IL 62301
Pharmacy Comments
Contract Details
Approval Date
1/10/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mark Conover, CRO
(573) 353-0014
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
1/10/2019
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