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Walmart Pharmacy 10-7611
CHC08769-00 PINES HEALTH SERVICES
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Covered Entity Details
Entity Name
PINES HEALTH SERVICES
Subdivision Name
Type
HRSA-Funded Health Center
340B ID
CHC08769-00
Entity Address
74 ACCESS HIGHWAY
CARIBOU, ME 04736
Grant Number
H80CS08769
Participating Start Date
4/1/2009
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
10/3/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kris Doody, CEO
(207) 498-2356
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
10/3/2023
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