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WALMART PHARMACY 10-5169
CH080730 METRO COMMUNITY PROVIDER NETWORK, INC.
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Covered Entity Details
Entity Name
METRO COMMUNITY PROVIDER NETWORK, INC.
Subdivision Name
STRIDE CHC- Peoria
Type
HRSA-Funded Health Center
340B ID
CH080730
Entity Address
3292 Peoria St
Aurora, CO 80010
Grant Number
H80CS00217
Participating Start Date
12/1/1992
Last Recertification Date
2/21/2025
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
4/7/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/29/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Santos vera, President/CEO
(949) 572-0958
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/7/2023
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