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WALMART PHARMACY 10-5169
CH0423770 NORTHEAST FLORIDA HEALTH SERVICES, INC.
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Covered Entity Details
Entity Name
NORTHEAST FLORIDA HEALTH SERVICES, INC.
Subdivision Name
PIERSON Family Health Source
Type
HRSA-Funded Health Center
340B ID
CH0423770
Entity Address
216 N. FREDERICK ST.
PIERSON, FL 32180
Grant Number
H80CS02520
Participating Start Date
10/1/2004
Last Recertification Date
2/20/2025
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
7/10/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/2/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Laurie Asbury, CEO
(386) 624-1054
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
7/10/2023
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