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WAL-MART PHARMACY 10-5997
CH020560 Mosaic Health, Inc.
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Covered Entity Details
Entity Name
Mosaic Health, Inc.
Subdivision Name
Mosaic Health Finger Lakes Administration
Type
HRSA-Funded Health Center
340B ID
CH020560
Entity Address
1 S Washington Street
Suite 300
Rochester, NY 14614-1134
Grant Number
H80CS00167
Participating Start Date
9/9/2005
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5997
Pharmacy Address
9600 PARKSOUTH CT. SUITE 100
ORLANDO, FL 32837
Pharmacy Comments
Contract Details
Approval Date
7/17/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael J Leary, President/CEO
(585) 325-2280 Ext: 7302
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
7/17/2017
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