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Walmart Pharmacy 10-7611
CH013240 KATAHDIN VALLEY HEALTH CENTER
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Covered Entity Details
Entity Name
KATAHDIN VALLEY HEALTH CENTER
Subdivision Name
KATAHDIN VALLEY HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH013240
Entity Address
30 Houlton St
Patten, ME 04765
Grant Number
H80CS00488
Participating Start Date
1/1/2005
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
10/4/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Claudette Humphrey, CEO
(207) 538-3700 Ext: 320
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/4/2023
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