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WAL-MART PHARMACY 10-2191
CH0516380 HEALTH PARTNERS OF WESTERN OHIO
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Covered Entity Details
Entity Name
HEALTH PARTNERS OF WESTERN OHIO
Subdivision Name
Dr.Gene Wright Community Health Center
Type
HRSA-Funded Health Center
340B ID
CH0516380
Entity Address
441 E 8th St,
Lima, OH 45804-2482
Grant Number
H80CS04212
Participating Start Date
1/1/2005
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2191
Pharmacy Address
1215 S. MAIN
BRYAN, OH 43506
Pharmacy Comments
Contract Details
Approval Date
10/3/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/8/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jennifer Clark, CPHO
(419) 221-3072 Ext: 1600
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
10/3/2019
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