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WAL-MART PHARMACY 10-2040
CH03414A SPECTRUM HEALTH SERVICES, INC.
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Covered Entity Details
Entity Name
SPECTRUM HEALTH SERVICES, INC.
Subdivision Name
BROAD STREET HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH03414A
Entity Address
1415 N Broad St STE 224
Philadelphia, PA 19122-3325
Grant Number
H80CS00389
Participating Start Date
10/1/2016
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2040
Pharmacy Address
2106 MT HOLLY RD
BURLINGTON, NJ 08016
Pharmacy Comments
Contract Details
Approval Date
4/3/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/8/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Stephanie Wroten, Chief Programs and Develop
(215) 471-2761 Ext: 3256
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/3/2019
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