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WALMART PHARMACY 10-5169
CH034120 ROANE FAMILY HEALTH CARE
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Covered Entity Details
Entity Name
ROANE FAMILY HEALTH CARE
Subdivision Name
ROANE COUNTY FAMILY HEALTH CARE
Type
HRSA-Funded Health Center
340B ID
CH034120
Entity Address
146 Williams Dr
Spencer, WV 25276-1826
Grant Number
H80CS00388
Participating Start Date
7/1/2004
Last Recertification Date
2/14/2025
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
7/7/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Rebecca Gaughan, CEO
(304) 927-8170
Contract Pharmacy Representative
RCFHC
Rebecca Gaughan, CEO
(304) 927-8170
Signed By Date
7/7/2023
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