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WAL-MART PHARMACY 10-0357
CH0714960 REGIONAL HEALTH CARE CLINIC, INC.
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Covered Entity Details
Entity Name
REGIONAL HEALTH CARE CLINIC, INC.
Subdivision Name
REGIONAL HEALTH CARE CLINIC, INC., dba Katy Trail Community Health
Type
HRSA-Funded Health Center
340B ID
CH0714960
Entity Address
821 Westwood Dr
Sedalia, MO 65301-2102
Grant Number
H80CS06668
Participating Start Date
11/7/2005
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0357
Pharmacy Address
1003 WEST NEWTON ST
PO BOX 12
VERSAILLES, MO 65084
Pharmacy Comments
Contract Details
Approval Date
10/7/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Chris Stewart, CEO
(660) 826-1571 Ext: 3
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
10/7/2016
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