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WALMART PHARMACY 10-5169
FQHCLA424 Monticello Medical Associates, Inc
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Covered Entity Details
Entity Name
Monticello Medical Associates, Inc
Subdivision Name
Monticello Medical Associates
Type
Health Center Program Look-Alike
340B ID
FQHCLA424
Entity Address
1 S Creek Dr Ste 102
Monticello, KY 42633-9472
Grant Number
LALCS40210
Participating Start Date
7/1/2021
Last Recertification Date
2/13/2025
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
1/12/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ROBERT PARMELEE, CEO
(606) 348-3365 Ext: 240
Contract Pharmacy Representative
Walmart
Julie Howard, 340b Program Manager
(479) 739-1973 Ext: 4792771498
Signed By Date
1/12/2023
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