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WAL-MART PHARMACY 10-1631
CH032240 PENINSULA INSTITUTE FOR COMMUNITY HEALTH (PICH)
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Covered Entity Details
Entity Name
PENINSULA INSTITUTE FOR COMMUNITY HEALTH (PICH)
Subdivision Name
DBA 48TH STREET PHYSICIANS
Type
HRSA-Funded Health Center
340B ID
CH032240
Entity Address
4714 MARSHALL AVENUE
NEWPORT NEWS, VA 23607-2247
Grant Number
H80CS00073
Participating Start Date
12/1/1992
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1631
Pharmacy Address
1900 CUNNINGHAM DR
HAMPTON, VA 23666
Pharmacy Comments
Contract Details
Approval Date
4/14/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ANGELA FUTRELL, CEO
(757) 591-0643 Ext: 1120
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
4/14/2017
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