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WAL-MART PHARMACY WHSE #45
CHC24692-00 MOUNTAIN COMPREHENSIVE CARE CENTER, INC.
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Covered Entity Details
Entity Name
MOUNTAIN COMPREHENSIVE CARE CENTER, INC.
Subdivision Name
HomePlace Clinic - Paintsville
Type
HRSA-Funded Health Center
340B ID
CHC24692-00
Entity Address
1110 S Mayo Trl STE A
Paintsville, KY 41240-1273
Grant Number
H80CS24692
Participating Start Date
10/1/2012
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY WHSE #45
Pharmacy Address
2250 NORTH 8TH STREET
SUITE 102-A
ROGERS, AR 72756
Pharmacy Comments
Contract Details
Approval Date
10/6/2023
Contract Begin Date
10/6/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/6/2023
Agreement registered in error
Contacts
Covered Entity Signing Official
Rachel Willoughby, Program Director
(606) 886-4319
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/6/2023
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