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Walmart Pharmacy 10-7611
CHC24198-00 Marillac Community Health Centers
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Covered Entity Details
Entity Name
Marillac Community Health Centers
Subdivision Name
DCHC-Carrollton
Type
HRSA-Funded Health Center
340B ID
CHC24198-00
Entity Address
3201 S. Carrollton Ave.
New Orleans, LA 70118-4307
Grant Number
H80CS24198
Participating Start Date
10/1/2012
Last Recertification Date
2/10/2025
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
Michael Griffin, President and CEO
(504) 212-9502
Contract Pharmacy Representative
Walmart
Van Donn, Director of Contracting 340b
(303) 261-5549
Signed By Date
10/6/2023
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