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WAL-MART PHARMACY 10-5174
CH047080 MOBILE COUNTY BOARD OF HEALTH
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Covered Entity Details
Entity Name
MOBILE COUNTY BOARD OF HEALTH
Subdivision Name
FAMILY ORIENTED PRIMARY HEALTH CARE CLIN
Type
HRSA-Funded Health Center
340B ID
CH047080
Entity Address
251 N Bayou St
Mobile, AL 36603-5827
Grant Number
H80CS00318
Participating Start Date
12/1/1992
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5174
Pharmacy Address
7855 MOFFETT RD
SEMMES, AL 36575
Pharmacy Comments
Contract Details
Approval Date
7/15/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/28/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kelly R Warren, Executive Director
(251) 690-8832
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
7/15/2020
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