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WAL-MART PHARMACY 10-5236
CH0421240 FAIRVIEW COMMUNITY HEALTH CENTER
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Covered Entity Details
Entity Name
FAIRVIEW COMMUNITY HEALTH CENTER
Subdivision Name
DBA FAIRVIEW COMMUNITY HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH0421240
Entity Address
225 NATCHEZ TRACE AVE
BOWLING GREEN, KY 42103-7995
Grant Number
H80CS00856
Participating Start Date
10/1/2001
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5236
Pharmacy Address
1201 MORGANTOWN ROAD
BOWLING GREEN (NW), KY 42101
Pharmacy Comments
Contract Details
Approval Date
4/14/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
John Lillybridge, Executive Director
(270) 783-3573 Ext: 1032
Contract Pharmacy Representative
Walmart
Julie Howard, 340b Program Manager
(479) 739-1973 Ext: 4792771498
Signed By Date
4/14/2023
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