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WALMART PHARMACY 10-5169
CH040400 Southside Medical Center, Inc.
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Covered Entity Details
Entity Name
Southside Medical Center, Inc.
Subdivision Name
SOUTHSIDE MEDICAL CENTER - Main Center / Corporate HQ
Type
HRSA-Funded Health Center
340B ID
CH040400
Entity Address
1046 Ridge Ave SW
Atlanta, GA 30315-1640
Grant Number
H80CS00576
Participating Start Date
12/1/1992
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
4/7/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Claudio Azzariti, CFO
(404) 564-7009
Contract Pharmacy Representative
RXStrategy
Jennifer Voelker, Client Manager
(561) 910-5164
Signed By Date
4/7/2023
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