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WAL-MART PHARMACY 10-0825
FQHCLA422D FAITH HEALTHCARE INC
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Covered Entity Details
Entity Name
FAITH HEALTHCARE INC
Subdivision Name
Paintsville Community Care
Type
Health Center Program Look-Alike
340B ID
FQHCLA422D
Entity Address
236 College St
Paintsville, KY 41240-1098
Grant Number
LALCS40209
Participating Start Date
10/1/2023
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0825
Pharmacy Address
1283 US HIGHWAY 27 NORTH
STANFORD, KY 40484
Pharmacy Comments
Contract Details
Approval Date
9/8/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Timothy Carnes, 340B Program Co-Director/Chief Pharmacy Officer
(270) 566-1074
Contract Pharmacy Representative
Walmart
Van Donn, Director of Contracting 340b
(303) 261-5549
Signed By Date
7/17/2023
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