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WAL-MART PHARMACY 10-5997
CH083800 Midtown Community Health Center, Inc.
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Covered Entity Details
Entity Name
Midtown Community Health Center, Inc.
Subdivision Name
MIDTOWN COMMUNITY HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH083800
Entity Address
2240 Adams Ave
Ogden, UT 84401-1511
Grant Number
H80CS00831
Participating Start Date
1/1/2004
Last Recertification Date
2/10/2025
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
4/10/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/10/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Alicia Martinez, Chief Executive Officer
(801) 334-1321
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/10/2020
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