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WALMART PHARMACY 10-5169
CH102910 KLAMATH HEALTH PARTNERSHIP, INC
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Covered Entity Details
Entity Name
KLAMATH HEALTH PARTNERSHIP, INC
Subdivision Name
Klamath Open Door Family Practice
Type
HRSA-Funded Health Center
340B ID
CH102910
Entity Address
2074 S 6th St
Klamath Falls, OR 97601-3372
Grant Number
H80CS00233
Participating Start Date
4/1/2001
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
Signe Porter, CFO
(541) 851-8110 Ext: 2022
Contract Pharmacy Representative
Klamath Health Partnership, Inc
Marcus Cox, Chief Pharmacy Officer
(541) 887-8188
Signed By Date
1/17/2023
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