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WALLY'S PHARMACY
CH044030 HEALTH & HUMAN SERVICES, NORTH CAROLINA DEPARTMENT OF
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Covered Entity Details
Entity Name
HEALTH & HUMAN SERVICES, NORTH CAROLINA DEPARTMENT OF
Subdivision Name
NC DEPARTMENT OF HEALTH AND HUMAN SERVICES
Type
HRSA-Funded Health Center
340B ID
CH044030
Entity Address
311 ASHE AVE 2009 MAIL SERVIC
RALEIGH, NC 27606-2102
Grant Number
H80CS00315
Participating Start Date
7/1/2004
Last Recertification Date
3/3/2025
Pharmacy Details
Pharmacy Name
WALLY'S PHARMACY
Pharmacy Address
933 ROCKFORD ST STE 5
MOUNT AIRY, NC 27030
Pharmacy Comments
Contract Details
Approval Date
7/10/2009
Contract Begin Date
7/10/2009
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/17/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
LIN HAMILTON, OWNER/ HEAD PHARMACIST
(336) 789-9089
Signed By Date
6/30/2009
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