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WALMART PHARMACY 10-5169
CH083270 BUTTE-SILVER BOW PRIMARY HEALTH CARE CLINIC, INC
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Covered Entity Details
Entity Name
BUTTE-SILVER BOW PRIMARY HEALTH CARE CLINIC, INC
Subdivision Name
BUTTE-SILVER BOW PRIMARY HEALTH CARE
Type
HRSA-Funded Health Center
340B ID
CH083270
Entity Address
445 Centennial Ave.
Butte, MT 59701-2870
Grant Number
H80CS00799
Participating Start Date
7/1/1998
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
1/17/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michele K Davis, CFO
(406) 496-6025
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/17/2023
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