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WAL-MART PHARMACY 10-1203
CH041750 SUNCOAST COMMUNITY HEALTH CENTERS, INC.
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Covered Entity Details
Entity Name
SUNCOAST COMMUNITY HEALTH CENTERS, INC.
Subdivision Name
SUNCOAST COMMUNITY HEALTH CENTERS, INC.
Type
HRSA-Funded Health Center
340B ID
CH041750
Entity Address
820 15th ST SE
Ruskin, FL 33570
Grant Number
H80CS00541
Participating Start Date
12/1/1992
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1203
Pharmacy Address
4928 STATE ROAD 674
WIMAUMA, FL 33598
Pharmacy Comments
Contract Details
Approval Date
10/9/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/6/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Bradley Herremans, CEO
(813) 653-6268
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
10/9/2020
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