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WAL-MART PHARMACY 10-2872
CHC29011-00 PACKARD HEALTH, INC.
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Covered Entity Details
Entity Name
PACKARD HEALTH, INC.
Subdivision Name
Packard Health Carpenter
Type
HRSA-Funded Health Center
340B ID
CHC29011-00
Entity Address
2650 Carpenter Road
Ann Arbor, MI 48108
Grant Number
H80CS29011
Participating Start Date
4/1/2016
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2872
Pharmacy Address
10562 BELLEVILLE ROAD
VAN BUREN TOWNSHIP, MI 48111
Pharmacy Comments
Contract Details
Approval Date
10/12/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Todd R Montrief, Controller
(734) 926-4935
Contract Pharmacy Representative
340Best
Kartik Joneja, VP
(845) 243-6198
Signed By Date
10/12/2021
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