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WAL-MART PHARMACY 10-5160
CH057030 CENTER FOR FAMILY HEALTH
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Covered Entity Details
Entity Name
CENTER FOR FAMILY HEALTH
Subdivision Name
CFH - Downtown
Type
HRSA-Funded Health Center
340B ID
CH057030
Entity Address
505 N.Jackson St.
Jackson, MI 49201
Grant Number
H80CS00772
Participating Start Date
7/1/2004
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5160
Pharmacy Address
1700 W MICHIGAN AVE
JACKSON(W), MI 49202
Pharmacy Comments
Contract Details
Approval Date
10/10/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/4/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
MOLLY KASER, CEO
(517) 748-5500
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
10/10/2016
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