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WAL-MART PHARMACY 10-3397
STD33169 ALIVE and WELL COMMUNITY PARTNERS
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Covered Entity Details
Entity Name
ALIVE and WELL COMMUNITY PARTNERS
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD33169
Entity Address
18425 N.W. 2ND AVENUE
5TH FLOOR
PH-7
MIAMI, FL 33169
Grant Number
NH25PS005131
Participating Start Date
1/1/2020
Last Recertification Date
6/2/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-3397
Pharmacy Address
17650 NW 2ND AVE.
MIAMI GARDENS, FL 33169
Pharmacy Comments
Contract Details
Approval Date
7/15/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
FRANKIE TAYLOR, DIRECTOR OF OPERATIONS
(800) 434-1366 Ext: 1002
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
7/15/2023
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