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WAL-MART PHARMACY 10-5842
CH0530900 WESTERN WAYNE FAMILY HEALTH CENTERS
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Covered Entity Details
Entity Name
WESTERN WAYNE FAMILY HEALTH CENTERS
Subdivision Name
Western Wayne Family Health Centers
Type
HRSA-Funded Health Center
340B ID
CH0530900
Entity Address
2700 Hamlin Dr,
INKSTER, MI 48141
Grant Number
H80CS06663
Participating Start Date
10/1/2006
Last Recertification Date
3/7/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5842
Pharmacy Address
14900 DIX TOLEDO
SOUTHGATE, MI 48195
Pharmacy Comments
Contract Details
Approval Date
4/15/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
LINDA ATKINS, CEO
(313) 561-5100 Ext: 210
Contract Pharmacy Representative
Wal-Mart
Marcus Osbourne, VP of Health and Wellness Transformation
(479) 204-9374
Signed By Date
4/15/2016
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