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WALMART PHARMACY 10-5169
FQHCLA361 ADULT AND CHILD HEALTH INC
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Covered Entity Details
Entity Name
ADULT AND CHILD HEALTH INC
Subdivision Name
Adult and Child Health - Irvington
Type
Health Center Program Look-Alike
340B ID
FQHCLA361
Entity Address
5839 E. Washington Street
Indianapolis, IN 46219
Grant Number
LALCS31537
Participating Start Date
4/1/2018
Last Recertification Date
2/26/2025
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
1/13/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/5/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jessica Stembel, Chief Clinical Officer
(317) 494-0739
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/13/2023
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