340B Drug Pricing Program Database
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Walmart Pharmacy 10-7611
CHC33661-00 Good Shepherd Community Clinic, Inc.
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Covered Entity Details
Entity Name
Good Shepherd Community Clinic, Inc.
Subdivision Name
Good Shepherd Community Clinic, Inc.
Type
HRSA-Funded Health Center
340B ID
CHC33661-00
Entity Address
20 12th Avenue NW
Ardmore, OK 73401-5722
Grant Number
H80CS33661
Participating Start Date
1/1/2020
Last Recertification Date
2/13/2025
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
Teresa Mae Myers, CEO
(580) 465-3545
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/3/2023
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