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WAL-MART CENTRAL FILL 10-2670
CHC24165-00 North Country Family Health Center, Inc.
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Covered Entity Details
Entity Name
North Country Family Health Center, Inc.
Subdivision Name
North Country Family Health Center - Main Campus
Type
HRSA-Funded Health Center
340B ID
CHC24165-00
Entity Address
238 Arsenal St
Watertown, NY 13601-2504
Grant Number
H80CS24165
Participating Start Date
10/27/2012
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART CENTRAL FILL 10-2670
Pharmacy Address
608 SPRING HILL DR # 3 SUITE 300
SPRING, TX 77386
Pharmacy Comments
Contract Details
Approval Date
10/11/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/22/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Joey Marie Horton, Chief Executive Officer
(315) 782-9450
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
10/11/2019
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