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WALMART PHARMACY 10-5169
CHC10584-00 CENTER STREET COMMUNITY C
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Covered Entity Details
Entity Name
CENTER STREET COMMUNITY C
Subdivision Name
Center Street Community Health Center
Type
HRSA-Funded Health Center
340B ID
CHC10584-00
Entity Address
136 W Center St
Marion, OH 43302-3704
Grant Number
H80CS10584
Participating Start Date
7/1/2009
Last Recertification Date
2/28/2025
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
4/10/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Cliff Edwards, CEO
(740) 751-6614
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
4/10/2023
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