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WAL-MART PHARMACY 10-2064
CH026250 MIDDLETOWN COMMUNITY HEALTH CENTER INC
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Covered Entity Details
Entity Name
MIDDLETOWN COMMUNITY HEALTH CENTER INC
Subdivision Name
MIDDLETOWN COMMUNITY HEALTH CENTER, INC.
Type
HRSA-Funded Health Center
340B ID
CH026250
Entity Address
21 Orchard St
Middletown, NY 10940-5004
Grant Number
H80CS00782
Participating Start Date
10/1/2001
Last Recertification Date
2/14/2017
Entity Termination Date
4/1/2018
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2064
Pharmacy Address
220 ROUTE 6 & 209
MILFORD, PA 18337
Pharmacy Comments
Contract Details
Approval Date
7/17/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2018
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Theresa M. Butler, CEO
(845) 343-7614
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
7/17/2017
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