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WALMART PHARMACY 10-5169
FQHC638492A Cow Creek Band of Umpqua Tribe Indians
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Covered Entity Details
Entity Name
Cow Creek Band of Umpqua Tribe Indians
Subdivision Name
Cow Creek Health & Wellness Center
Type
Tribal Contract/Compact with IHS (P.L. 93-638)
340B ID
FQHC638492A
Entity Address
2589 NW Edenbower Blvd
Roseburg, OR 97471
Grant Number
Participating Start Date
7/1/2019
Last Recertification Date
2/26/2025
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
5/9/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Sharon Arlene Stanphill, Health Operations Officer
(541) 672-8533 Ext: 5517
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
5/9/2023
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