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WAL-MART PHARMACY 10-5203
CHC12892-00 ROCKING HORSE CENTER
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Covered Entity Details
Entity Name
ROCKING HORSE CENTER
Subdivision Name
Type
HRSA-Funded Health Center
340B ID
CHC12892-00
Entity Address
651 SOUTH LIMESTONE STREET
SPRINGFIELD, OH 45505
Grant Number
H80CS12892
Participating Start Date
7/1/2009
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5203
Pharmacy Address
375 LAFAYETTE ST
LONDON, OH 43140
Pharmacy Comments
Contract Details
Approval Date
10/14/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kent Youngman, CEO
(937) 324-1111 Ext: 190
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
10/14/2020
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