Contract Pharmacy Details

WAL-MART PHARMACY 10-0488
CH040380 NORTH FLORIDA MEDICAL CENTERS, INC.

Covered Entity Details

Entity Name

NORTH FLORIDA MEDICAL CENTERS, INC.

Subdivision Name

North Florida Medical Centers, Inc.

Type

HRSA-Funded Health Center

340B ID

CH040380

Entity Address

2804 Remington Green Cir
Tallahassee, FL 32308-8707

Grant Number

H80CS00693

Participating Start Date

4/1/2001

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

WAL-MART PHARMACY 10-0488

Pharmacy Address

1940 PAT THOMAS PARKWAY
QUINCY, FL 32351

Pharmacy Comments

Contract Details

Approval Date

7/7/2015

Contract Begin Date

10/1/2015

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Tori Wiggins, CFO
(850) 298-6040

Contract Pharmacy Representative

Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374

Signed By Date

7/7/2015

340B Drug Pricing Program Database