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WALMART PHARMACY 10-5169
CHC26511-08 UPPER GREAT LAKES FAMILY HEALTH CENTER
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Covered Entity Details
Entity Name
UPPER GREAT LAKES FAMILY HEALTH CENTER
Subdivision Name
Menominee Family Health Center
Type
HRSA-Funded Health Center
340B ID
CHC26511-08
Entity Address
1110 10th Ave
Menominee, MI 49858
Grant Number
H80CS26511
Participating Start Date
10/1/2014
Last Recertification Date
2/12/2025
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
5/3/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Donald A. Simila, CEO
(906) 481-8571
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
5/3/2023
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