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WAL-MART PHARMACY 10-5997
CH101188B Community Council of Idaho, Inc.
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Covered Entity Details
Entity Name
Community Council of Idaho, Inc.
Subdivision Name
Community Family Clinic Idaho Falls
Type
HRSA-Funded Health Center
340B ID
CH101188B
Entity Address
2100 Alan STREET
IDAHO FALLS, ID 83404
Grant Number
H80CS04201
Participating Start Date
9/9/2005
Last Recertification Date
2/13/2025
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
Arnold Cantu, ADMINISTRATOR
(208) 528-7655 Ext: 3519
Contract Pharmacy Representative
Walmart
George Flaherty, Sr Director, Payer Programs
(479) 739-1973
Signed By Date
4/15/2022
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