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WAL-MART PHARMACY 10-4283
CH043340 CareConnect Health, Inc.
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Covered Entity Details
Entity Name
CareConnect Health, Inc.
Subdivision Name
CareConnect Family Practice and Pediatrics
Type
HRSA-Funded Health Center
340B ID
CH043340
Entity Address
510 Alston Street
Suite A
Richland, GA 31825-1404
Grant Number
H80CS00393
Participating Start Date
4/1/2002
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-4283
Pharmacy Address
2801 AIRPORT THRUWAY
COLUMBUS, GA 31909
Pharmacy Comments
Contract Details
Approval Date
10/11/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Ajay Gehlot, CEO
(229) 273-8881
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
10/11/2021
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