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WAL-MART PHARMACY 10-2854
FQHCLA150 UNITED COMMUNITY & FAMILY SERVICES, INC.
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Covered Entity Details
Entity Name
UNITED COMMUNITY & FAMILY SERVICES, INC.
Subdivision Name
Type
Health Center Program Look-Alike
340B ID
FQHCLA150
Entity Address
47 TOWN STREET
NORWICH, CT 06360
Grant Number
LALCS00072
Participating Start Date
10/1/2003
Last Recertification Date
2/19/2015
Entity Termination Date
1/1/2016
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2854
Pharmacy Address
180 RIVER ROAD
LISBON, CT 06351
Pharmacy Comments
Contract Details
Approval Date
10/16/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/14/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Joanne Smart, CFO
(860) 822-4153
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
10/16/2014
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