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WALMART PHARMACY 10-5169
CH091300 CANYONLANDS COMMUNITY HEALTH CARE
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Covered Entity Details
Entity Name
CANYONLANDS COMMUNITY HEALTH CARE
Subdivision Name
Canyonlands Healthcare - Lake Powell
Type
HRSA-Funded Health Center
340B ID
CH091300
Entity Address
467 VISTA AVENUE
PAGE, AZ 86040
Grant Number
H80CS00448
Participating Start Date
10/1/1998
Last Recertification Date
2/11/2025
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
1/4/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Christopher Hansen, CEO
(928) 645-6600
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
1/4/2023
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