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WALMART PHARMACY 10-5169
CH059840 WHITESIDE, COUNTY OF
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Covered Entity Details
Entity Name
WHITESIDE, COUNTY OF
Subdivision Name
WHITESIDE CHD - ROCK FALLS
Type
HRSA-Funded Health Center
340B ID
CH059840
Entity Address
1300 W 2nd St
Rock Falls, IL 61071-1005
Grant Number
H80CS06660
Participating Start Date
7/1/2006
Last Recertification Date
2/10/2025
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
1/5/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Cheryl Lee, PHA/CEO
(815) 626-2230 Ext: 1283
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/5/2023
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