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WALMART PHARMACY 10-5169
FQHCLA422B Faith Healthcare, Inc
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Covered Entity Details
Entity Name
Faith Healthcare, Inc
Subdivision Name
Science Hill Community Care
Type
Health Center Program Look-Alike
340B ID
FQHCLA422B
Entity Address
5775 N Highway 27 Ste 6
Science Hill, KY 42553-9140
Grant Number
LALCS40209
Participating Start Date
9/10/2021
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
1/16/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Timothy Carnes, 340B Program Co-Director/Chief Pharmacy Officer
(270) 566-1074
Contract Pharmacy Representative
Walmart
Van Donn, Director of Contracting 340b
(303) 261-5549
Signed By Date
1/16/2023
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