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WAL-MART PHARMACY 10-5997
FQHCLA390 MERCY MEDICAL HEALTH CENTER
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Covered Entity Details
Entity Name
MERCY MEDICAL HEALTH CENTER
Subdivision Name
Mercy Medical Health Center
Type
Health Center Program Look-Alike
340B ID
FQHCLA390
Entity Address
244 Bond Street
Jonesboro, LA 71251
Grant Number
LALCS31662
Participating Start Date
7/1/2019
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5997
Pharmacy Address
9600 PARKSOUTH CT. SUITE 100
ORLANDO, FL 32837
Pharmacy Comments
Contract Details
Approval Date
1/10/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kim Brunson, CEO
(318) 259-1100
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/10/2020
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