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WAL-MART PHARMACY 10-5443
FQHCLA361 ADULT AND CHILD HEALTH INC
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Covered Entity Details
Entity Name
ADULT AND CHILD HEALTH INC
Subdivision Name
Adult and Child Health - Irvington
Type
Health Center Program Look-Alike
340B ID
FQHCLA361
Entity Address
5839 E. Washington Street
Indianapolis, IN 46219
Grant Number
LALCS31537
Participating Start Date
4/1/2018
Last Recertification Date
2/26/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5443
Pharmacy Address
4650 SOUTH EMERSON AVE.
INDIANAPOLIS, IN 46203
Pharmacy Comments
Contract Details
Approval Date
10/8/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/5/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Dan Arens, Chief Operating Officer
(317) 893-0336
Contract Pharmacy Representative
Adult and Child Health
Dan Arens, Chief Operating Officer
(317) 893-0336
Signed By Date
10/8/2021
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