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WAL-MART PHARMACY 10-2338
CH050390 NORTHWEST MICHIGAN HEALTH SERVICES, INC
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Covered Entity Details
Entity Name
NORTHWEST MICHIGAN HEALTH SERVICES, INC
Subdivision Name
NORTHWEST MICHIGAN HEALTH SERVICES, INC.
Type
HRSA-Funded Health Center
340B ID
CH050390
Entity Address
10767 E Traverse Hwy
Traverse City, MI 49684-6219
Grant Number
H80CS00669
Participating Start Date
1/1/1997
Last Recertification Date
2/28/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2338
Pharmacy Address
2640 CROSSING CIRCLE
TRAVERSE CITY, MI 49684
Pharmacy Comments
Contract Details
Approval Date
7/15/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/25/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Heidi Britton, Chief Executive Officer
(231) 947-1112
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
7/15/2021
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