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WAL-MART PHARMACY 10-1026
CHC33650-03 SOUTHERN INDIANA COMMUNITY HEALTH CARE, INC
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Covered Entity Details
Entity Name
SOUTHERN INDIANA COMMUNITY HEALTH CARE, INC
Subdivision Name
SICHC Marengo
Type
HRSA-Funded Health Center
340B ID
CHC33650-03
Entity Address
5604 E White Oak Ln
Marengo, IN 47140-8413
Grant Number
H80CS33650
Participating Start Date
7/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1026
Pharmacy Address
3200 JOHN WILLIAMS BLVD
BEDFORD, IN 47421
Pharmacy Comments
Contract Details
Approval Date
2/28/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Nancy Radcliff, CEO
(812) 723-3944
Contract Pharmacy Representative
Wal-mart
Laura Levine, Manager Contracting
(479) 204-8550
Signed By Date
2/27/2020
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