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WAL-MART PHARMACY 10-5315
CH031270 FAMILY HEALTH CENTERS OF BALTIMORE, INC.
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Covered Entity Details
Entity Name
FAMILY HEALTH CENTERS OF BALTIMORE, INC.
Subdivision Name
HEADQUARTERS
Type
HRSA-Funded Health Center
340B ID
CH031270
Entity Address
631 CHERRY HILL ROAD
BALTIMORE, MD 21225
Grant Number
H80CS00436
Participating Start Date
7/1/1996
Last Recertification Date
1/30/2023
Entity Termination Date
1/1/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5315
Pharmacy Address
2354 COMMERCE PARK DR.
ORLANDO, FL 32819
Pharmacy Comments
Contract Details
Approval Date
10/14/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Brian Aoki Hawkins, President and Chief Executive Officer
(410) 354-2001
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/14/2019
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