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WAL-MART PHARMACY 10-5437
CH052730 OPEN CITIES HEALTH CENTER
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Covered Entity Details
Entity Name
OPEN CITIES HEALTH CENTER
Subdivision Name
OPEN CITIES HEALTH CENTER, INC.
Type
HRSA-Funded Health Center
340B ID
CH052730
Entity Address
409 Dunlap St N
Saint Paul, MN 55104-4201
Grant Number
H80CS00112
Participating Start Date
10/1/2001
Last Recertification Date
2/23/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5437
Pharmacy Address
1450 UNIVERSITY AVE W
ST PAUL (MIDWAY), MN 55104
Pharmacy Comments
Contract Details
Approval Date
7/18/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/27/2018
Pharmacy closed
Contacts
Covered Entity Signing Official
James Platten, CEO
(651) 290-9245
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
7/18/2017
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