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WAL-MART PHARMACY 10-2424
CH02179B HUDSON HEADWATERS HEALTH NETWORK
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Covered Entity Details
Entity Name
HUDSON HEADWATERS HEALTH NETWORK
Subdivision Name
NORTH CREEK HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH02179B
Entity Address
126 SKI BOWL RD
NORTH CREEK, NY 12853
Grant Number
H80CS00159
Participating Start Date
4/1/2001
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2424
Pharmacy Address
1134 WICKER STREET
TICONDEROGA, NY 12883
Pharmacy Comments
Contract Details
Approval Date
1/24/2013
Contract Begin Date
1/24/2013
Carve-In Effective Date
Contract Comments
01/24/2013 - public health emergency declared in the state of NY effective 10/27/2012, immediate start date authorized
Contacts
Covered Entity Signing Official
George Purdue, Chief Administrative Officer
(518) 761-0300 Ext: 31114
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
1/14/2013
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