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WAL-MART PHARMACY 10-5263
CH04123J OCOEE REGIONAL HEALTH CORPORATION
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Covered Entity Details
Entity Name
OCOEE REGIONAL HEALTH CORPORATION
Subdivision Name
MEIGS COUNTY PRIMARY CARE
Type
HRSA-Funded Health Center
340B ID
CH04123J
Entity Address
305 River Rd
DECATUR, TN 37322-7801
Grant Number
H80CS00762
Participating Start Date
7/1/2015
Last Recertification Date
2/28/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5263
Pharmacy Address
2300 TREASURY DR SE
CLEVELAND (S), TN 37323
Pharmacy Comments
Contract Details
Approval Date
6/1/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/19/2021
Agreement registered in error
Contacts
Covered Entity Signing Official
BILL MOATS, CEO
(423) 338-8995 Ext: 1212
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
6/1/2015
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