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WAL-MART PHARMACY 10-5997
CH102480 COWLITZ FAMILY HEALTH CENTER
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Covered Entity Details
Entity Name
COWLITZ FAMILY HEALTH CENTER
Subdivision Name
COWLITZ FAMILY HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH102480
Entity Address
1057 12th Ave
Longview, WA 98632-2509
Grant Number
H80CS00542
Participating Start Date
1/1/2004
Last Recertification Date
2/11/2025
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
4/15/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
JIm Coffee, CEO
(360) 636-3892
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/15/2022
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