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WAL-MART PHARMACY 10-2646
CHC26516-01 Free Clinic Of The New River Valley Inc
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Covered Entity Details
Entity Name
Free Clinic Of The New River Valley Inc
Subdivision Name
Giles Clinic
Type
HRSA-Funded Health Center
340B ID
CHC26516-01
Entity Address
219 Buchanan St
Pearisburg, VA 24134-1901
Grant Number
H80CS26516
Participating Start Date
10/1/2019
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2646
Pharmacy Address
160 KINTER WAY
PEARISBURG, VA 24134
Pharmacy Comments
Contract Details
Approval Date
4/21/2023
Contract Begin Date
4/24/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Matthew Pitonyak, Chief Financial Officer
(540) 232-9960
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/21/2023
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