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Walmart Pharmacy 10-7611
CHC08239-00 PRAIRIESTAR HEALTH CENTER INC
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Covered Entity Details
Entity Name
PRAIRIESTAR HEALTH CENTER INC
Subdivision Name
PRAIRIESTAR HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CHC08239-00
Entity Address
2700 E 30TH AVE
HUTCHINSON, KS 67502
Grant Number
H80CS08239
Participating Start Date
4/1/2012
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
10/3/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Bryant Anderson, Chief Executive Officer
(620) 802-0035
Contract Pharmacy Representative
Walmart
Julie Howard, 340b Program Manager
(479) 739-1973 Ext: 4792771498
Signed By Date
10/3/2023
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