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Walmart Pharmacy 10-7611
CHC08746-02 United Cerebral Palsy Association of the North Country, Inc.
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Covered Entity Details
Entity Name
United Cerebral Palsy Association of the North Country, Inc.
Subdivision Name
Type
HRSA-Funded Health Center
340B ID
CHC08746-02
Entity Address
77 W Barney St
Gouverneur, NY 13642-1040
Grant Number
H80CS08746
Participating Start Date
7/1/2014
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
Anne F. Richey, CEO
(315) 379-8310
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
10/4/2023
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