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Walmart Pharmacy 10-7611
CH10717A PENINSULA COMMUNITY HEALTH SERVICES OF ALASKA, INC.
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Covered Entity Details
Entity Name
PENINSULA COMMUNITY HEALTH SERVICES OF ALASKA, INC.
Subdivision Name
Peninsula Community Health Services of Alaska
Type
HRSA-Funded Health Center
340B ID
CH10717A
Entity Address
230 East Marydale Ave
SOLDOTNA, AK 99669-7524
Grant Number
H80CS01139
Participating Start Date
10/1/2015
Last Recertification Date
2/19/2025
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
Benjamin Wright, Chief Executive Officer
(907) 260-7314
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
10/2/2023
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