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WAL-MART PHARMACY 10-5997
CHC26510-03 Southwest Colorado Mental Health Center, Inc.
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Covered Entity Details
Entity Name
Southwest Colorado Mental Health Center, Inc.
Subdivision Name
Dove Creek Integrated Healthcare
Type
HRSA-Funded Health Center
340B ID
CHC26510-03
Entity Address
495 W 4th St
Dove Creek, CO 81324-4900
Grant Number
H80CS26510
Participating Start Date
6/4/2020
Last Recertification Date
2/12/2025
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
7/17/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/6/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Pamela Wise Romero, COO
(970) 335-2202
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
7/17/2020
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