Contract Pharmacy Details

WAL-MART PHARMACY 10-1940
CH020110 WHITNEY M. YOUNG, JR., HEALTH CENTER, INC.

Covered Entity Details

Entity Name

WHITNEY M. YOUNG, JR., HEALTH CENTER, INC.

Subdivision Name

WHITNEY M. YOUNG, JR. HEALTH CENTER

Type

HRSA-Funded Health Center

340B ID

CH020110

Entity Address

920 Lark Dr
Albany, NY 12207-1300

Grant Number

H80CS00433

Participating Start Date

10/1/1995

Last Recertification Date

2/14/2025

Pharmacy Details

Pharmacy Name

WAL-MART PHARMACY 10-1940

Pharmacy Address

279 TROY RD
RENSSELAER, NY 12144

Pharmacy Comments

Contract Details

Approval Date

1/17/2020

Contract Begin Date

4/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

9/11/2020
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

David Harold Shippee, President & CEO
(518) 591-4459

Contract Pharmacy Representative

Walmart
Julie Howard, 340B Program Manager
(479) 277-1498

Signed By Date

1/17/2020

340B Drug Pricing Program Database