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Walmart Pharmacy 10-7611
CHC12848 WESLEY COMMUNITY CENTER INC
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Covered Entity Details
Entity Name
WESLEY COMMUNITY CENTER INC
Subdivision Name
Wesley Health Center
Type
HRSA-Funded Health Center
340B ID
CHC12848
Entity Address
1300 S. 10th St.
Phoenix, AZ 85034-4518
Grant Number
H80CS12848
Participating Start Date
7/1/2012
Last Recertification Date
2/25/2025
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
Contract Termination Date
Termination Reason
3/10/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Blaine Bandi, Chief Executive Officer
(602) 368-9616
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/4/2023
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