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WALMART PHARMACY 10-5169
CH10076D NORTHWEST HUMAN SERVICES, INC.
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Covered Entity Details
Entity Name
NORTHWEST HUMAN SERVICES, INC.
Subdivision Name
WEST SALEM DENTAL CLINIC
Type
HRSA-Funded Health Center
340B ID
CH10076D
Entity Address
1233 Edgewater St NW STE D
SALEM, OR 97304
Grant Number
H80CS00148
Participating Start Date
10/1/2004
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
7/12/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
PAUL LOGAN, CEO
(503) 588-5828 Ext: 831
Contract Pharmacy Representative
Welllpartner
Kristen Hartlen, Sr. Account Manager
(480) 364-2573
Signed By Date
7/12/2023
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