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WALMART PHARMACY 10-5169
CHC11422-00 MT. ENTERPRISE COMMUNITY HEALTH CLINIC
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Covered Entity Details
Entity Name
MT. ENTERPRISE COMMUNITY HEALTH CLINIC
Subdivision Name
Type
HRSA-Funded Health Center
340B ID
CHC11422-00
Entity Address
106 WEST RUSK STREET
MT. ENTERPRISE, TX 75681
Grant Number
H80CS12856
Participating Start Date
10/1/2007
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
4/5/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Rolando Reyes, Director of Healthcare Programs
(430) 247-5419
Contract Pharmacy Representative
Walmart
Julie Howard, 340b Program Manager
(479) 739-1973 Ext: 4792771498
Signed By Date
4/5/2023
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