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WAL-MART PHARMACY 10-0886
CH0715040 COMMUNITY HEALTH CENTER OF FORT DODGE, INC
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Covered Entity Details
Entity Name
COMMUNITY HEALTH CENTER OF FORT DODGE, INC
Subdivision Name
COMMUNITY HEALTH CENTER OF FORT DODGE
Type
HRSA-Funded Health Center
340B ID
CH0715040
Entity Address
126 N 10th St
Fort Dodge, IA 50501-3915
Grant Number
H80CS06667
Participating Start Date
4/1/2006
Last Recertification Date
3/4/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0886
Pharmacy Address
3036 1ST AVENUE SOUTH
FORT DODGE, IA 50501
Pharmacy Comments
Contract Details
Approval Date
4/1/2013
Contract Begin Date
7/1/2013
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Renae Kruckenberg, CEO
(515) 576-6500 Ext: 1021
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
4/1/2013
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