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WAL-MART PHARMACY 10-2092
CHC08746-03 UNITED CEREBRAL PALSY ASSOCIATION OF THE NORTH COUNTRY, INC.
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Covered Entity Details
Entity Name
UNITED CEREBRAL PALSY ASSOCIATION OF THE NORTH COUNTRY, INC.
Subdivision Name
Community Health Center of the North Country
Type
HRSA-Funded Health Center
340B ID
CHC08746-03
Entity Address
102 Ford Street
Ogdensburg, NY 13669-1402
Grant Number
H80CS08746
Participating Start Date
4/1/2020
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2092
Pharmacy Address
3000 FORD ST. EXTENSION
OGDENSBURG, NY 13669
Pharmacy Comments
Contract Details
Approval Date
2/28/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Anne F. Richey, CEO
(315) 379-8310
Contract Pharmacy Representative
UCPA of the North Country, Inc. dba Community Health Center of the North Country
Anne F. Richey, CEO
(315) 379-8310
Signed By Date
1/11/2020
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