Contract Pharmacy Details

WALMART PHARMACY 10-5968
CH037030 Mary's Center For Maternal And Child Care, Inc.

Covered Entity Details

Entity Name

Mary's Center For Maternal And Child Care, Inc.

Subdivision Name

Adams Morgan DC

Type

HRSA-Funded Health Center

340B ID

CH037030

Entity Address

2333 Ontario Rd NW
Washington, DC 20009-2627

Grant Number

H80CS04202

Participating Start Date

7/1/2014

Last Recertification Date

2/27/2025

Pharmacy Details

Pharmacy Name

WALMART PHARMACY 10-5968

Pharmacy Address

5929 GEORGIA AVE NW
WASHINGTON, DC 20011

Pharmacy Comments

Contract Details

Approval Date

7/12/2021

Contract Begin Date

10/1/2021

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Dara Koppelman, EVP of Health Services and Programs
(202) 545-2063

Contract Pharmacy Representative

Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498

Signed By Date

7/12/2021

340B Drug Pricing Program Database