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WAL-MART PHARMACY 10-0774
CH07803B East Central District Health Dept
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Covered Entity Details
Entity Name
East Central District Health Dept
Subdivision Name
Good Neighbor Fremont Clinic Permanent Site
Type
HRSA-Funded Health Center
340B ID
CH07803B
Entity Address
2740 N Clarkson
Fremont, NE 68025-7716
Grant Number
H80CS00862
Participating Start Date
4/1/2018
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0774
Pharmacy Address
818 EAST 23RD ST.
COLUMBUS, NE 68601
Pharmacy Comments
Contract Details
Approval Date
10/15/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Beth M Wewel, Cfo
(402) 562-8951
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
10/15/2019
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