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WAL-MART PHARMACY 10-2477
CHC24101-00 ADAPT
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Covered Entity Details
Entity Name
ADAPT
Subdivision Name
FQHC- Main Winston
Type
HRSA-Funded Health Center
340B ID
CHC24101-00
Entity Address
671 SW Main St
Winston, OR 97496-9660
Grant Number
H80CS24101
Participating Start Date
4/1/2014
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2477
Pharmacy Address
2125 NW STEWART PKWY
ROSEBURG, OR 97471
Pharmacy Comments
Contract Details
Approval Date
7/10/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Gregory Brigham, CEO
(541) 672-2691 Ext: 208
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
7/10/2020
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