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WAL-MART PHARMACY 10-3503
CH045630 GASTON FAMILY HEALTH SERVICES INC
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Covered Entity Details
Entity Name
GASTON FAMILY HEALTH SERVICES INC
Subdivision Name
Kintegra Family Medicine - Hudson
Type
HRSA-Funded Health Center
340B ID
CH045630
Entity Address
991 W Hudson Blvd
Gastonia, NC 28052-6430
Grant Number
H80CS00293
Participating Start Date
10/1/1997
Last Recertification Date
3/5/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-3503
Pharmacy Address
1585 LIBERTY DRIVE, STE #1
THOMASVIELLE, NC 27360
Pharmacy Comments
Contract Details
Approval Date
7/15/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Robert Spencer, CEO
(704) 616-2245
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
7/15/2019
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