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WALMART PHARMACY 10-5169
FQHCLA370 His Branches, Inc.
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Covered Entity Details
Entity Name
His Branches, Inc.
Subdivision Name
His Branches Inc.: Grace Family Medicine
Type
Health Center Program Look-Alike
340B ID
FQHCLA370
Entity Address
340 ARNETT BLVD
ROCHESTER, NY 14619-1147
Grant Number
LALCS31626
Participating Start Date
7/1/2018
Last Recertification Date
3/5/2025
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
Josh Moody, Financial Director
(585) 235-9000
Contract Pharmacy Representative
Walmart
Julie Howard, 340b Program Manager
(479) 739-1973 Ext: 4792771498
Signed By Date
1/16/2023
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