Contract Pharmacy Details

WAL-MART PHARMACY 10-0011
CH024690 COMMUNITY HEALTH CENTER OF BUFFALO, INC.

Covered Entity Details

Entity Name

COMMUNITY HEALTH CENTER OF BUFFALO, INC.

Subdivision Name

34 Benwood Ave Buffalo, NY 14214

Type

HRSA-Funded Health Center

340B ID

CH024690

Entity Address

34 Benwood
Buffalo, NY 14214-1761

Grant Number

H80CS00157

Participating Start Date

4/1/2003

Last Recertification Date

2/13/2025

Pharmacy Details

Pharmacy Name

WAL-MART PHARMACY 10-0011

Pharmacy Address

65 WAL-MART DRIVE
MOUNTAIN HOME, AR 72653

Pharmacy Comments

Contract Details

Approval Date

7/14/2021

Contract Begin Date

10/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/14/2021
Agreement registered in error

Contacts

Covered Entity Signing Official

LaVonne Ansari, CEO
(716) 986-9199 Ext: 1002

Contract Pharmacy Representative

WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498

Signed By Date

7/14/2021

340B Drug Pricing Program Database