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WAL-MART PHARMACY 10-2163
CH010810 South-West Community Health Center, Inc.
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Covered Entity Details
Entity Name
South-West Community Health Center, Inc.
Subdivision Name
SOUTHWEST COMMUNITY HLTH CTR, INC
Type
HRSA-Funded Health Center
340B ID
CH010810
Entity Address
46 Albion St
Bridgeport, CT 06605-2602
Grant Number
H80CS00613
Participating Start Date
1/1/2004
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2163
Pharmacy Address
465 BRIDGEPORT AVE
SHELTON, CT 06484
Pharmacy Comments
Contract Details
Approval Date
7/8/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Mollie Melbourne, President/CEO
(203) 332-3501
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
7/8/2019
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