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WAL-MART PHARMACY 10-0825
FQHCLA422A Faith Healthcare, Inc
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Covered Entity Details
Entity Name
Faith Healthcare, Inc
Subdivision Name
Nancy Family Care
Type
Health Center Program Look-Alike
340B ID
FQHCLA422A
Entity Address
9919 W Highway 80
Nancy, KY 42544-9003
Grant Number
LALCS40209
Participating Start Date
9/10/2021
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
7/17/2023
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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