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WALMART PHARMACY 10-5169
CH013470 SAINT CROIX REGIONAL FAMILY HEALTH CENTER
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Covered Entity Details
Entity Name
SAINT CROIX REGIONAL FAMILY HEALTH CENTER
Subdivision Name
ST. CROIX REGIONAL FAMILY HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH013470
Entity Address
136 Mill St
Princeton, ME 04668-3344
Grant Number
H80CS00526
Participating Start Date
7/1/2001
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
1/17/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Corinne A. LaPlant, CEO
(207) 796-5503
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/17/2023
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