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WAL-MART PHARMACY 10-0599
CH041279Q Rural Health Services Consortium, Inc.
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Covered Entity Details
Entity Name
Rural Health Services Consortium, Inc.
Subdivision Name
Mobile Unit 2
Type
HRSA-Funded Health Center
340B ID
CH041279Q
Entity Address
4966 Highway 11w
Rogersville, TN 37857
Grant Number
H80CS00421
Participating Start Date
7/1/2018
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0599
Pharmacy Address
3200 FORT HENRY DR
KINGSPORT, TN 37664
Pharmacy Comments
Contract Details
Approval Date
5/3/2023
Contract Begin Date
5/4/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
LINDA W. BUCK, CHIEF EXECUTIVE OFFICER
(423) 272-9163 Ext: 8901
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
5/3/2023
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