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WAL-MART PHARMACY 10-1866
CH01046G HEALTHREACH COMMUNITY HEALTH CENTERS
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Covered Entity Details
Entity Name
HEALTHREACH COMMUNITY HEALTH CENTERS
Subdivision Name
SHEEPSCOT VALLEY HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH01046G
Entity Address
47 MAIN STREET
COOPERS MILLS, ME 04341-0000
Grant Number
H80CS00797
Participating Start Date
10/1/2001
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1866
Pharmacy Address
615 WILTON ROAD
FARMINGTON, ME 04938
Pharmacy Comments
Contract Details
Approval Date
4/30/2012
Contract Begin Date
5/3/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
CONSTANCE COGGINS, CEO
(207) 872-5610
Contract Pharmacy Representative
Wal--Mart
Marcus Osborne, Sales & Contracting
(479) 204-8452
Signed By Date
4/27/2012
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