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WAL-MART PHARMACY #10-1728
FQHCLA354 ASPIRE HEALTH CENTER
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Covered Entity Details
Entity Name
ASPIRE HEALTH CENTER
Subdivision Name
Aspire Indiana Health - Carmel
Type
Health Center Program Look-Alike
340B ID
FQHCLA354
Entity Address
697 Pro-med Lane
Carmel, IN 46032-5323
Grant Number
LALCS31260
Participating Start Date
1/1/2018
Last Recertification Date
3/4/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY #10-1728
Pharmacy Address
2321 CHARLES STREET
ANDERSON, IN 46013
Pharmacy Comments
Contract Details
Approval Date
7/15/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/11/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jerry Landers, VP, Strategy & Business Development
(317) 587-0508
Contract Pharmacy Representative
Walmart
Julie Howard, 340b Program Manager
(479) 739-1973 Ext: 4792771498
Signed By Date
7/15/2022
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