Contract Pharmacy Details

WAL-MART PHARMACY 10-5129
CHC10591-00 COMMUNITY CLINIC, INC.

Covered Entity Details

Entity Name

COMMUNITY CLINIC, INC.

Subdivision Name

CCI-Takoma Park

Type

HRSA-Funded Health Center

340B ID

CHC10591-00

Entity Address

7676 NEW HAMPSHIRE AVENUE
Suite 200
TAKOMA PARK, MD 20912

Grant Number

H80CS10591

Participating Start Date

4/1/2005

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

WAL-MART PHARMACY 10-5129

Pharmacy Address

6210 ANNAPOLIS RD
LANDOVER HILLS, MD 20784

Pharmacy Comments

Contract Details

Approval Date

10/15/2020

Contract Begin Date

1/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/1/2021
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Sonya J. Bruton, CEO and President
(240) 839-5107

Contract Pharmacy Representative

Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498

Signed By Date

10/15/2020

340B Drug Pricing Program Database