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WALMART PHARMACY 10-5169
CH031600 TRI-STATE COMMUNITY HEALTH CENTER
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Covered Entity Details
Entity Name
TRI-STATE COMMUNITY HEALTH CENTER
Subdivision Name
TRI-STATE COMMUNITY HEALTH CENTER, INC.
Type
HRSA-Funded Health Center
340B ID
CH031600
Entity Address
130 W High St
Hancock, MD 21750-1143
Grant Number
H80CS00069
Participating Start Date
12/1/1992
Last Recertification Date
3/10/2025
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
4/14/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
SHEILA DESHONG, COO
(301) 678-5187 Ext: 226
Contract Pharmacy Representative
Walmart
Julie Howard, 340b Program Manager
(479) 739-1973 Ext: 4792771498
Signed By Date
4/14/2023
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