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WAL-MART PHARMACY 10-1974
CH013240 KATAHDIN VALLEY HEALTH CENTER
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Covered Entity Details
Entity Name
KATAHDIN VALLEY HEALTH CENTER
Subdivision Name
KATAHDIN VALLEY HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH013240
Entity Address
30 Houlton St
Patten, ME 04765
Grant Number
H80CS00488
Participating Start Date
1/1/2005
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1974
Pharmacy Address
17 LUDLOW ROAD
HOULTON, ME 04730
Pharmacy Comments
Contract Details
Approval Date
2/1/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Durward Humphrey, CEO
(207) 528-2285 Ext: 308
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
1/16/2013
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