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WAL-MART PHARMACY 10-5997
CH081260E Mountain Family Health Centers
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Covered Entity Details
Entity Name
Mountain Family Health Centers
Subdivision Name
Mountain Family Health Centers Rifle
Type
HRSA-Funded Health Center
340B ID
CH081260E
Entity Address
195 W. 14th St., Bldg C
Rifle, CO 81650-4717
Grant Number
H80CS00830
Participating Start Date
10/1/2011
Last Recertification Date
2/11/2025
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
10/16/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Art M Fernandez, Chief Operating Officer
(970) 945-2840 Ext: 7205
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/16/2020
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