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WALMART PHARMACY 10-5169
CHC12854-00 HealthCore Clinic Inc
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Covered Entity Details
Entity Name
HealthCore Clinic Inc
Subdivision Name
HealthCore Clinic Inc
Type
HRSA-Funded Health Center
340B ID
CHC12854-00
Entity Address
2707 E 21st St N
Wichita, KS 67214-2249
Grant Number
H80CS12854
Participating Start Date
1/1/2010
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
1/13/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
TERESA LOVELADY, CHIEF EXECUTIVE OFFICER
(316) 691-9404
Contract Pharmacy Representative
HealthCore Clinic
TERESA LOVELADY, CHIEF EXECUTIVE OFFICER
(316) 691-9404
Signed By Date
1/13/2023
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