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WAL-MART PHARMACY 10-0860
CH0423770 NORTHEAST FLORIDA HEALTH SERVICES, INC.
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Covered Entity Details
Entity Name
NORTHEAST FLORIDA HEALTH SERVICES, INC.
Subdivision Name
PIERSON Family Health Source
Type
HRSA-Funded Health Center
340B ID
CH0423770
Entity Address
216 N. FREDERICK ST.
PIERSON, FL 32180
Grant Number
H80CS02520
Participating Start Date
10/1/2004
Last Recertification Date
2/20/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0860
Pharmacy Address
1699 N. WOODLAND BLVD
DE LAND, FL 32720
Pharmacy Comments
Contract Details
Approval Date
4/20/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Laurie Asbury, CEO
(386) 624-1054
Contract Pharmacy Representative
Walmart
George Flaherty, Senior Director Payer Programs
(479) 204-9374
Signed By Date
4/20/2021
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