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WALMART PHARMACY 10-5169
CH07440A DOUGLAS COUNTY PUBLIC HEALTH SERVICES GROUP, INC.
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Covered Entity Details
Entity Name
DOUGLAS COUNTY PUBLIC HEALTH SERVICES GROUP, INC.
Subdivision Name
DOUGLAS COUNTY PUBLIC HEALTH
Type
HRSA-Funded Health Center
340B ID
CH07440A
Entity Address
504 W. Broadway Ave.
AVA, MO 65608-1359
Grant Number
H80CS00457
Participating Start Date
4/1/2004
Last Recertification Date
2/25/2025
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
4/6/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tim R Shryack, CEO
(417) 683-4831 Ext: 110
Contract Pharmacy Representative
CVS/Wellpartner
Ebony Jefferson, Regional Account Executive
(414) 239-1665
Signed By Date
4/6/2023
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