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WAL-MART PHARMACY 10-5315
CH107930 KODIAK ISLAND HEALTH CARE FOUNDATION
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Covered Entity Details
Entity Name
KODIAK ISLAND HEALTH CARE FOUNDATION
Subdivision Name
KODIAK COMMUNITY HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH107930
Entity Address
1911 E Rezanof Dr
Kodiak, AK 99615-6602
Grant Number
H80CS01445
Participating Start Date
4/1/2004
Last Recertification Date
2/20/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5315
Pharmacy Address
2354 COMMERCE PARK DR.
ORLANDO, FL 32819
Pharmacy Comments
Contract Details
Approval Date
10/12/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/16/2020
Agreement registered in error
Contacts
Covered Entity Signing Official
Carol Austerman, Executive Director/CEO
(907) 481-5002
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
10/12/2020
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