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WAL-MART PHARMACY 10-1856
HV00729 Health Equity Alliance (HEAL)
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Covered Entity Details
Entity Name
Health Equity Alliance (HEAL)
Subdivision Name
Type
Ryan White Part C
340B ID
HV00729
Entity Address
5 Long Lane
Suite 1
Ellsworth, ME 04605
Grant Number
H76HA00729
Participating Start Date
4/1/2017
Last Recertification Date
2/11/2025
Entity Termination Date
4/1/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1856
Pharmacy Address
900 STILLWATER AVENUE
BANGOR, ME 04401
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
4/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Jennifer L Thompson, President
(207) 888-2895
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/14/2022
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