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WAL-MART PHARMACY 10-2760
FQHCLA429 Physicians Care of Clarke
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Covered Entity Details
Entity Name
Physicians Care of Clarke
Subdivision Name
Fulton Family Medical
Type
Health Center Program Look-Alike
340B ID
FQHCLA429
Entity Address
218 Main St
Fulton, AL 36446-0065
Grant Number
LALCS43504
Participating Start Date
1/1/2022
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2760
Pharmacy Address
4206 COLLEGE AVENUE
JACKSON, AL 36545
Pharmacy Comments
Contract Details
Approval Date
10/14/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
FARRELL A TURNER, CEO
(256) 201-0095
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/14/2021
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