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WAL-MART PHARMACY 10-4389
CH0112220 LITTLE RIVERS HEALTH CARE, INC.
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Covered Entity Details
Entity Name
LITTLE RIVERS HEALTH CARE, INC.
Subdivision Name
Wells River
Type
HRSA-Funded Health Center
340B ID
CH0112220
Entity Address
65 Main St N
Wells River, VT 05081
Grant Number
H80CS06658
Participating Start Date
10/1/2006
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-4389
Pharmacy Address
WAL-MART STORES EAST, LP
4901 DARTMOUTH COLLEGE HWY
WOODSVILLE, NH 03785
Pharmacy Comments
Contract Details
Approval Date
1/14/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
GAIL AUCLAIR, CEO
(802) 222-4637 Ext: 104
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
1/14/2014
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