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WAL-MART PHARMACY 10-5997
CH015110 HEALTH ACCESS NETWORK
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Covered Entity Details
Entity Name
HEALTH ACCESS NETWORK
Subdivision Name
Health Access Network Lincoln
Type
HRSA-Funded Health Center
340B ID
CH015110
Entity Address
175 WEST BROADWAY
LINCOLN, ME 04457
Grant Number
H80CS02450
Participating Start Date
1/1/2004
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5997
Pharmacy Address
9600 PARKSOUTH CT. SUITE 100
ORLANDO, FL 32837
Pharmacy Comments
Contract Details
Approval Date
1/12/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mike Osborne, CFO
(207) 794-6700 Ext: 7510
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
1/12/2017
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