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WALMART PHARMACY 10-5169
CH031700 CENTERVILLE CLINIC INC
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Covered Entity Details
Entity Name
CENTERVILLE CLINIC INC
Subdivision Name
CENTERVILLE CLINICS, INC.; Joseph Yablonski Memorial Clinic
Type
HRSA-Funded Health Center
340B ID
CH031700
Entity Address
1070 OLD NATIONAL PIKE
FREDERICKTOWN, PA 15333-2114
Grant Number
H80CS00705
Participating Start Date
4/1/1995
Last Recertification Date
2/20/2025
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
Barry R Niccolai, Executive Director
(724) 632-6801 Ext: 1100
Contract Pharmacy Representative
Walmart
Julie Howard, 340b Program Manager
(479) 739-1973 Ext: 4792771498
Signed By Date
1/16/2023
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