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WAL-MART PHARMACY 10-1652
CHC26516-00 Free Clinic Of The New River Valley Inc
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Covered Entity Details
Entity Name
Free Clinic Of The New River Valley Inc
Subdivision Name
Montgomery Clinic
Type
HRSA-Funded Health Center
340B ID
CHC26516-00
Entity Address
215 Roanoke St
Christiansburg, VA 24073-3025
Grant Number
H80CS26516
Participating Start Date
10/1/2019
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1652
Pharmacy Address
5225 ALEXANDER ROAD
DUBLIN, VA 24084
Pharmacy Comments
Contract Details
Approval Date
4/15/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Matthew Pitonyak, Chief Financial Officer
(540) 232-9960
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/15/2020
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