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WAL-MART PHARMACY 10-3364
CH053020 WEST SIDE COMMUNITY HEALTH SERVICES, INC.
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Covered Entity Details
Entity Name
WEST SIDE COMMUNITY HEALTH SERVICES, INC.
Subdivision Name
WESTSIDE COMMUNITY HEALTH SERVICES, INC.
Type
HRSA-Funded Health Center
340B ID
CH053020
Entity Address
153 Cesar Chavez St
Saint Paul, MN 55107-2226
Grant Number
H80CS00790
Participating Start Date
1/1/1997
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-3364
Pharmacy Address
1644 SOUTH ROBERT STREET SOUTH
WEST ST.PAUL, MN 55118
Pharmacy Comments
Contract Details
Approval Date
4/15/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/26/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Reuben Moore, President & Executive Officer
(651) 602-7536
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/15/2019
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