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Walmart Pharmacy 10-7611
CH0530900 WESTERN WAYNE FAMILY HEALTH CENTERS
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Covered Entity Details
Entity Name
WESTERN WAYNE FAMILY HEALTH CENTERS
Subdivision Name
Western Wayne Family Health Centers
Type
HRSA-Funded Health Center
340B ID
CH0530900
Entity Address
2700 Hamlin Dr,
INKSTER, MI 48141
Grant Number
H80CS06663
Participating Start Date
10/1/2006
Last Recertification Date
3/7/2025
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
10/6/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
LINDA ATKINS, CEO
(313) 561-5100 Ext: 210
Contract Pharmacy Representative
Walmart
Van Donn, Director of Contracting 340b
(303) 261-5549
Signed By Date
10/6/2023
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