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WAL-MART PHARMACY 10-2936
CH0511020 PROGRESSIVE COMMUNITY HEALTH CENTERS, INC
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Covered Entity Details
Entity Name
PROGRESSIVE COMMUNITY HEALTH CENTERS, INC
Subdivision Name
LISBON AVENUE HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH0511020
Entity Address
3522 W Lisbon Ave
Milwaukee, WI 53208-1953
Grant Number
H80CS00751
Participating Start Date
4/1/2008
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2936
Pharmacy Address
10330 W SILVER SPRINGS DR
MILWAUKEE, WI 53225
Pharmacy Comments
12/10/2012 address update (was 8700 NORTH SERVITE DRIVE 53223)
Contract Details
Approval Date
7/10/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
JENNI SEVENICH, CEO
(414) 934-9465
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
7/10/2019
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