Contract Pharmacy Details

WAL-MART PHARMACY 10-2914
CHC33659-00 My Community Health Center

Covered Entity Details

Entity Name

My Community Health Center

Subdivision Name

My Community Health Center - Canton

Type

HRSA-Funded Health Center

340B ID

CHC33659-00

Entity Address

2600 7th St. SW
Canton, OH 44710-0000

Grant Number

H80CS33659

Participating Start Date

4/1/2020

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

WAL-MART PHARMACY 10-2914

Pharmacy Address

1 MASSILLON MARKET PLACE DR.
MASSILLON, OH 44646

Pharmacy Comments

Contract Details

Approval Date

1/4/2021

Contract Begin Date

4/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

2/11/2022
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Terry Regula, CEO
(330) 363-3179

Contract Pharmacy Representative

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

Signed By Date

1/4/2021

340B Drug Pricing Program Database