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WAL-MART PHARMACY 10-1665
CH0510700 OPEN DOOR HEALTH SERVICES, INC.
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Covered Entity Details
Entity Name
OPEN DOOR HEALTH SERVICES, INC.
Subdivision Name
Open Door Health Services
Type
HRSA-Funded Health Center
340B ID
CH0510700
Entity Address
333 S Madison Street
Suite 79
Muncie, IN 47305
Grant Number
H80CS00340
Participating Start Date
4/1/2001
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1665
Pharmacy Address
4801 W. CLARA LN
MUNCIE, IN 47304
Pharmacy Comments
Contract Details
Approval Date
4/13/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Toni Estep, CEO
(765) 747-2971
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
4/13/2015
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