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WALMART PHARMACY 10-5169
CH105600 Mosaic Community Health
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Covered Entity Details
Entity Name
Mosaic Community Health
Subdivision Name
Madras Health Center
Type
HRSA-Funded Health Center
340B ID
CH105600
Entity Address
500 NE A St Ste 100
Madras, OR 97741
Grant Number
H80CS00270
Participating Start Date
10/1/2003
Last Recertification Date
2/25/2025
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
Robin Vallie, Pharmacy Operations Manager
(541) 383-3005
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
1/13/2023
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