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WAL-MART PHARMACY 10-1991
CH053200 HealthNet, Inc.
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Covered Entity Details
Entity Name
HealthNet, Inc.
Subdivision Name
HealthNet Administration/HealthNet Specialty Care at Barrington
Type
HRSA-Funded Health Center
340B ID
CH053200
Entity Address
3403 E Raymond St
Indianapolis, IN 46203
Grant Number
H80CS00114
Participating Start Date
12/1/1992
Last Recertification Date
2/26/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1991
Pharmacy Address
3313 W. STATE RT.45
BLOOMINGTON, IN 47403
Pharmacy Comments
Contract Details
Approval Date
10/11/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Richard Reifenberg, Chief Medical Officer
(317) 957-2028
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
10/11/2019
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