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WALMART PHARMACY 10-5169
CHC08746-02 United Cerebral Palsy Association of the North Country, Inc.
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Covered Entity Details
Entity Name
United Cerebral Palsy Association of the North Country, Inc.
Subdivision Name
Type
HRSA-Funded Health Center
340B ID
CHC08746-02
Entity Address
77 W Barney St
Gouverneur, NY 13642-1040
Grant Number
H80CS08746
Participating Start Date
7/1/2014
Last Recertification Date
2/11/2025
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
Anne F. Richey, CEO
(315) 379-8310
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
1/17/2023
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