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WAL-MART PHARMACY 10-2634
CH010850 COOS COUNTY FAMILY HEALTH SERVICES, INC.
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Covered Entity Details
Entity Name
COOS COUNTY FAMILY HEALTH SERVICES, INC.
Subdivision Name
COOS COUNTY FAMILY HEALTH SVCS
Type
HRSA-Funded Health Center
340B ID
CH010850
Entity Address
133 Pleasant St
Berlin, NH 03570-2006
Grant Number
H80CS00508
Participating Start Date
7/1/2004
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2634
Pharmacy Address
561 MAIN STREET
GORHAM, NH 03581
Pharmacy Comments
Contract Details
Approval Date
1/14/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ADELE D. WOODS, CEO
(603) 752-3669 Ext: 4018
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
1/3/2013
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