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WALMART PHARMACY 10-5169
CH022070 ANTHONY L JORDAN HEALTH CORP
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Covered Entity Details
Entity Name
ANTHONY L JORDAN HEALTH CORP
Subdivision Name
Main Site
Type
HRSA-Funded Health Center
340B ID
CH022070
Entity Address
82 Holland St
Rochester, NY 14605-2131
Grant Number
H80CS21582
Participating Start Date
10/1/2011
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
1/25/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jonathan Clune, CFO
(585) 423-2813
Contract Pharmacy Representative
Walmart
Julie Howard, 340b Program Manager
(479) 739-1973 Ext: 4792771498
Signed By Date
1/25/2023
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