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WAL-MART PHARMACY 10-3515
FQHCLA346 HIGHLAND HEALTH PROVIDERS CORPORATION
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Covered Entity Details
Entity Name
HIGHLAND HEALTH PROVIDERS CORPORATION
Subdivision Name
Highland Health Providers
Type
Health Center Program Look-Alike
340B ID
FQHCLA346
Entity Address
1487 N. High St.
Suite102
Hillsboro, OH 45133-8496
Grant Number
LALCS00180
Participating Start Date
4/1/2017
Last Recertification Date
2/10/2020
Entity Termination Date
7/1/2020
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-3515
Pharmacy Address
540 HARRY SAUNER ROAD
HILLSBORO, OH 45133
Pharmacy Comments
Contract Details
Approval Date
1/14/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Amanda M Warix, Executive Director
(937) 393-5753
Contract Pharmacy Representative
Wal-mart
Laura Levine, Manager Contracting
(479) 204-8550
Signed By Date
1/14/2019
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