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WALMART PHARMACY 10-5169
CHC29834-03 PROMISE HEALTHCARE NFP
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Covered Entity Details
Entity Name
PROMISE HEALTHCARE NFP
Subdivision Name
Promise Healthcare at the USBHC
Type
HRSA-Funded Health Center
340B ID
CHC29834-03
Entity Address
1002 S. Race
Urbana, IL 61801
Grant Number
H80CS29834
Participating Start Date
10/1/2018
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
1/10/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/25/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jennifer Henry, Promise Healthcare Executive Director
(217) 403-5401
Contract Pharmacy Representative
Walmart
Julie Howard, 340b Program Manager
(479) 739-1973 Ext: 4792771498
Signed By Date
1/10/2023
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