Contract Pharmacy Details

WALMART PHARMACY 10-5169
CHC24101-00 ADAPT

Covered Entity Details

Entity Name

ADAPT

Subdivision Name

FQHC- Main Winston

Type

HRSA-Funded Health Center

340B ID

CHC24101-00

Entity Address

671 SW Main St
Winston, OR 97496-9660

Grant Number

H80CS24101

Participating Start Date

4/1/2014

Last Recertification Date

2/13/2025

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

4/11/2023

Contract Begin Date

7/1/2023

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Gregory Brigham, Authorizing Official
(541) 672-2961

Contract Pharmacy Representative

Walmart
Julie Howard, 340b Program Manager
(479) 739-1973 Ext: 4792771498

Signed By Date

4/11/2023

340B Drug Pricing Program Database