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WALMART PHARMACY 10-5169
CH038800 WIRT COUNTY HEALTH SERVICE ASSOCIATION, INC
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Covered Entity Details
Entity Name
WIRT COUNTY HEALTH SERVICE ASSOCIATION, INC
Subdivision Name
Wirt County Family Care
Type
HRSA-Funded Health Center
340B ID
CH038800
Entity Address
483 COURT STREET
ELIZABETH, WV 26143-0609
Grant Number
H80CS00256
Participating Start Date
4/1/2004
Last Recertification Date
2/18/2025
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
1/16/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Robby Eugene Dudley, CEO
(304) 275-3301
Contract Pharmacy Representative
Walmart
Van Donn, Director of Contracting 340b
(303) 261-5549
Signed By Date
1/16/2023
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