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WALMART PHARMACY #10-6190
CH04168D FAMILY HEALTH CENTERS OF SOUTHWEST FLORIDA, INC.
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Covered Entity Details
Entity Name
FAMILY HEALTH CENTERS OF SOUTHWEST FLORIDA, INC.
Subdivision Name
FORT MYERS CENTER - DOWNTOWN
Type
HRSA-Funded Health Center
340B ID
CH04168D
Entity Address
2232 GRAND AVE
FORT MYERS, FL 33901-3717
Grant Number
H80CS00185
Participating Start Date
4/1/1995
Last Recertification Date
3/4/2025
Pharmacy Details
Pharmacy Name
WALMART PHARMACY #10-6190
Pharmacy Address
1951 W HICKPOCHEE AVE
LABELLE, FL 33935
Pharmacy Comments
Contract Details
Approval Date
4/8/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Carrie Poulsom, VP & Chief Pharmacy Officer
(239) 344-2321
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/8/2019
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