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WAL-MART PHARMACY 10-5997
CH106300 BOUNDARY REGIONAL COMMUNITY HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
BOUNDARY REGIONAL COMMUNITY HEALTH CENTER, INC.
Subdivision Name
BOUNDARY REGIONAL CHC
Type
HRSA-Funded Health Center
340B ID
CH106300
Entity Address
6615 COMANCHE ST
BONNERS FERRY, ID 83805
Grant Number
H80CS00302
Participating Start Date
10/1/2004
Last Recertification Date
2/12/2025
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
7/19/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
VICTORIA McCLELLAN KING, CEO
(208) 263-7101 Ext: 2202
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
7/19/2017
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