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WALMART PHARMACY 10-5169
CH083950 MOUNTAINLANDS COMMUNITY HEALTH CENTER, INC
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Covered Entity Details
Entity Name
MOUNTAINLANDS COMMUNITY HEALTH CENTER, INC
Subdivision Name
Mountainlands Community Health Center Main Site Clinic
Type
HRSA-Funded Health Center
340B ID
CH083950
Entity Address
589 S. State Street
Provo, UT 84606-5056
Grant Number
H80CS00213
Participating Start Date
7/1/1995
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-5169
Pharmacy Address
2252 NORTH 8TH STREET
SUITE A
ROGERS, AR 72756
Pharmacy Comments
Contract Details
Approval Date
1/3/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/15/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Todd Bailey, Executive Director
(801) 429-2000 Ext: 1155
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/3/2023
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