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WAL-MART PHARMACY 10-1667
FQHCLA423 Bowen Health, INC.
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Covered Entity Details
Entity Name
Bowen Health, INC.
Subdivision Name
Bowen Health Clinic
Type
Health Center Program Look-Alike
340B ID
FQHCLA423
Entity Address
850 N Harrison St
Warsaw, IN 46580-3163
Grant Number
LALCS40296
Participating Start Date
7/1/2021
Last Recertification Date
2/24/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1667
Pharmacy Address
1601 N CASS ST
WABASH, IN 46992
Pharmacy Comments
Contract Details
Approval Date
4/14/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/13/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Daniel Carey, Senior VP, Healthcare Quality
(574) 526-1385
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/14/2022
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