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WAL-MART PHARMACY 10-1856
STD044011 Health Equity Alliance
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Covered Entity Details
Entity Name
Health Equity Alliance
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD044011
Entity Address
304 Hancock Street
Suite 3B
Bangor, ME 04401
Grant Number
6 NU62PS924567
Participating Start Date
12/10/2021
Last Recertification Date
5/7/2024
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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