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WALMART PHARMACY #10-6400
CH049070 COMMUNITY HEALTH CENTERS OF PINELLAS, INC.
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Covered Entity Details
Entity Name
COMMUNITY HEALTH CENTERS OF PINELLAS, INC.
Subdivision Name
Evara Health - Johnnie Ruth Clarke
Type
HRSA-Funded Health Center
340B ID
CH049070
Entity Address
1344 22nd St S
Saint Petersburg, FL 33712-2744
Grant Number
H80CS00463
Participating Start Date
12/1/1992
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WALMART PHARMACY #10-6400
Pharmacy Address
1794 22ND ST. SOUTH
SAINT PETERSBURG, FL 33712
Pharmacy Comments
Contract Details
Approval Date
4/17/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/2/2018
Pharmacy closed
Contacts
Covered Entity Signing Official
Pat Mabe, CEO
(727) 824-8100
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
4/17/2017
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