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WALMART PHARMACY 10-5169
FQHCLA344F Tri-County Family Medicine Program, Inc.
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Covered Entity Details
Entity Name
Tri-County Family Medicine Program, Inc.
Subdivision Name
TCFM Canaseraga
Type
Health Center Program Look-Alike
340B ID
FQHCLA344F
Entity Address
12 N Church St
Canaseraga, NY 14822-9721
Grant Number
LALCS00181
Participating Start Date
7/1/2022
Last Recertification Date
2/11/2025
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
Contacts
Covered Entity Signing Official
Nicholas H Apostoleris, CSIO
(585) 432-2300
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
1/13/2023
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