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WAL-MART PHARMACY 10-3420
CH02151CQ Sun River Health, Inc.
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Covered Entity Details
Entity Name
Sun River Health, Inc.
Subdivision Name
Harmony Healthcare Long Island at Westbury High School
Type
HRSA-Funded Health Center
340B ID
CH02151CQ
Entity Address
1 Post Rd
104
Westbury, NY 11568-1153
Grant Number
H80CS00313
Participating Start Date
7/1/2021
Last Recertification Date
2/24/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-3420
Pharmacy Address
1220 OLD COUNTRY ROAD
WESTBURY(, NY 11590
Pharmacy Comments
Contract Details
Approval Date
10/15/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/1/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Allison Dubois-Adach, COO
(914) 734-8503
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
10/15/2021
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