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WALMART PHARMACY 10-5169
CH05096K COMMUNITY & RURAL HEALTH SERVICES
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Covered Entity Details
Entity Name
COMMUNITY & RURAL HEALTH SERVICES
Subdivision Name
COMMUNITY HEALTH SERVICES - LIMA
Type
HRSA-Funded Health Center
340B ID
CH05096K
Entity Address
1005 Bellefontaine Avenue, Suite 300
Lima, OH 45804
Grant Number
H80CS00661
Participating Start Date
1/1/2017
Last Recertification Date
2/1/2023
Entity Termination Date
4/1/2024
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
4/17/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
JOSEPH LISZAK, CEO
(419) 334-8943 Ext: 225
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/17/2023
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