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WAL-MART PHARMACY 10-3897
CH101650 FAMILY HEALTH SERVICES CORPORATION
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Covered Entity Details
Entity Name
FAMILY HEALTH SERVICES CORPORATION
Subdivision Name
FAMILY HEALTH SERVICES - ADMINISTRATION
Type
HRSA-Funded Health Center
340B ID
CH101650
Entity Address
794 Eastland Dr
Twin Falls, ID 83301-6856
Grant Number
H80CS00425
Participating Start Date
1/1/2004
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-3897
Pharmacy Address
WAL-MART STORES INC.
252 CHENEY DR W
TWIN FALLS, ID 83301
Pharmacy Comments
Contract Details
Approval Date
1/14/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
LYNN HUDGENS, CEO
(208) 734-3312
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
1/14/2015
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