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WAL-MART PHARMACY 10-5997
CH0516820 M.G.H. FAMILY HEALTH CENTER
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Covered Entity Details
Entity Name
M.G.H. FAMILY HEALTH CENTER
Subdivision Name
MUSKEGON FAMILY CARE
Type
HRSA-Funded Health Center
340B ID
CH0516820
Entity Address
2201 S Getty St
Muskegon, MI 49444-1207
Grant Number
H80CS00865
Participating Start Date
1/1/2002
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
4/13/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Daniel Oglesby, CEO
(231) 739-9315 Ext: 1151
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/13/2020
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