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WALMART PHARMACY 10-5169
CH04571J Northeast Alabama Health Services, Inc.
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Covered Entity Details
Entity Name
Northeast Alabama Health Services, Inc.
Subdivision Name
NORTHEAST ALABAMA HEALTH SERVICES, INC. - FORT PAYNE
Type
HRSA-Funded Health Center
340B ID
CH04571J
Entity Address
3840 Gault Ave N
Fort Payne, AL 35967-5211
Grant Number
H80CS00760
Participating Start Date
1/1/2011
Last Recertification Date
2/19/2025
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
7/17/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
DEBORAH CULPEPPER, CEO
(256) 259-5313 Ext: 221
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
7/17/2023
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