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WAL-MART PHARMACY 10-5997
CH060110 JEFFERSON COMPREHENSIVE CARE SYSTEM, INC.
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Covered Entity Details
Entity Name
JEFFERSON COMPREHENSIVE CARE SYSTEM, INC.
Subdivision Name
JEFFERSON COMPREHENSIVE CARE SYSTEM, Inc.
Type
HRSA-Funded Health Center
340B ID
CH060110
Entity Address
1101 S Tennessee St
Pine Bluff, AR 71601-5801
Grant Number
H80CS00727
Participating Start Date
1/1/2007
Last Recertification Date
3/7/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5997
Pharmacy Address
9600 PARKSOUTH CT. SUITE 100
ORLANDO, FL 32837
Pharmacy Comments
Contract Details
Approval Date
7/12/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Sandra J. Brown, Chief Executive Officer
(870) 543-2300
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
7/12/2019
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