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WAL-MART PHARMACY 10-3191
CHC24157-02 Foothills Community Health Care, Inc.
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Covered Entity Details
Entity Name
Foothills Community Health Care, Inc.
Subdivision Name
Foothills Community Health Care - Clemson
Type
HRSA-Funded Health Center
340B ID
CHC24157-02
Entity Address
110 Liberty Drive
Clemson, SC 29631-3157
Grant Number
H80CS24157
Participating Start Date
4/1/2019
Last Recertification Date
2/27/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-3191
Pharmacy Address
2637 GENTRY MEMORIAL HIGHWAY
PICKENS, SC 29671
Pharmacy Comments
Contract Details
Approval Date
10/4/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/30/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Mark J Rajkowski, CEO
(864) 722-0283 Ext: 205
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/4/2019
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