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WAL-MART PHARMACY 10-5997
CH010060 FAIR HAVEN COMMUNITY HEALTH CLINIC INC
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Covered Entity Details
Entity Name
FAIR HAVEN COMMUNITY HEALTH CLINIC INC
Subdivision Name
FAIR HAVEN COMMUNITY HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH010060
Entity Address
374 Grand Ave
New Haven, CT 06513-3733
Grant Number
H80CS00741
Participating Start Date
7/1/2003
Last Recertification Date
2/15/2025
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
7/5/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
SUZANNE LAGARDE, CEO
(203) 752-5129
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
7/5/2017
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