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WAL-MART PHARMACY 10-1804
FQHCLA446 ALLIANCE HEALTH CENTERS INC
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Covered Entity Details
Entity Name
ALLIANCE HEALTH CENTERS INC
Subdivision Name
Alliance Health Center
Type
Health Center Program Look-Alike
340B ID
FQHCLA446
Entity Address
2700 Lafayette St STE 110
Fort Wayne, IN 46806-1100
Grant Number
LALCS45370
Participating Start Date
7/1/2023
Last Recertification Date
3/5/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1804
Pharmacy Address
1710 APPLE GLEN BLVD
FORT WAYNE, IN 46804
Pharmacy Comments
Contract Details
Approval Date
7/5/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Autumn N King, CEO
(606) 634-1456
Contract Pharmacy Representative
Walmart
Julie Howard, 340b Program Manager
(479) 739-1973 Ext: 4792771498
Signed By Date
7/5/2023
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