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Walmart Pharmacy 10-7611
CH05214H HENDERSON COUNTY RURAL HEALTH CENTER INC
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Covered Entity Details
Entity Name
HENDERSON COUNTY RURAL HEALTH CENTER INC
Subdivision Name
Eagle View Community Health System Monmouth Clinic
Type
HRSA-Funded Health Center
340B ID
CH05214H
Entity Address
230 S Main St
Monmouth, IL 61462-2160
Grant Number
H80CS00192
Participating Start Date
4/1/2023
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
10/2/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Shannon Courson, Executive Director
(309) 867-2202 Ext: 219
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/2/2023
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