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WAL-MART CENTRAL FILL 10-2670
CH102910 KLAMATH HEALTH PARTNERSHIP, INC
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Covered Entity Details
Entity Name
KLAMATH HEALTH PARTNERSHIP, INC
Subdivision Name
Klamath Open Door Family Practice
Type
HRSA-Funded Health Center
340B ID
CH102910
Entity Address
2074 S 6th St
Klamath Falls, OR 97601-3372
Grant Number
H80CS00233
Participating Start Date
4/1/2001
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WAL-MART CENTRAL FILL 10-2670
Pharmacy Address
608 SPRING HILL DR # 3 SUITE 300
SPRING, TX 77386
Pharmacy Comments
Contract Details
Approval Date
7/13/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Signe Porter, CFO
(541) 851-8110 Ext: 2022
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
7/13/2017
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