Contract Pharmacy Details

WAL-MART PHARMACY 10-2630
CH0452920 DIVERSITY HEALTH CENTER, INC.

Covered Entity Details

Entity Name

DIVERSITY HEALTH CENTER, INC.

Subdivision Name

Diversity Health Center, Inc.- Long County

Type

HRSA-Funded Health Center

340B ID

CH0452920

Entity Address

213 N McDonald Street STE A & B
Ludowici, GA 31316

Grant Number

H80CS08780

Participating Start Date

10/14/2008

Last Recertification Date

2/18/2025

Pharmacy Details

Pharmacy Name

WAL-MART PHARMACY 10-2630

Pharmacy Address

1100 NORTH FIRST ST
JESUP, GA 31545

Pharmacy Comments

Contract Details

Approval Date

4/14/2020

Contract Begin Date

7/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

6/30/2021
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Stephanie Jones-Heath, CEO
(912) 318-3947 Ext: 15

Contract Pharmacy Representative

Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498

Signed By Date

4/14/2020

340B Drug Pricing Program Database