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WAL-MART PHARMACY 10-5376
CH051980 ALCONA CITIZENS FOR HEALTH, INC.
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Covered Entity Details
Entity Name
ALCONA CITIZENS FOR HEALTH, INC.
Subdivision Name
Alcona Health Center-Lincoln Services
Type
HRSA-Funded Health Center
340B ID
CH051980
Entity Address
177 N Barlow Rd
Harrisville, MI 48740
Grant Number
H80CS00679
Participating Start Date
1/1/2002
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5376
Pharmacy Address
621 EAST LAKE STREET
TAWAS CITY, MI 48763
Pharmacy Comments
Contract Details
Approval Date
4/15/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Christine M. Baumgardner, CEO
(989) 736-9868
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
4/15/2014
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