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WALMART PHARMACY 10-5169
CHC24159-00 River Valley Health
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Covered Entity Details
Entity Name
River Valley Health
Subdivision Name
River Valley Health - Williamsport Medical and Dental
Type
HRSA-Funded Health Center
340B ID
CHC24159-00
Entity Address
471 Hepburn St
Williamsport, PA 17701-6122
Grant Number
H80CS24159
Participating Start Date
4/1/2013
Last Recertification Date
2/12/2025
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
4/4/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jim Yoxtheimer, President & CEO
(570) 567-5412
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
4/4/2023
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