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Walmart Pharmacy 10-7611
CHC29834-03 PROMISE HEALTHCARE NFP
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Covered Entity Details
Entity Name
PROMISE HEALTHCARE NFP
Subdivision Name
Promise Healthcare at the USBHC
Type
HRSA-Funded Health Center
340B ID
CHC29834-03
Entity Address
1002 S. Race
Urbana, IL 61801
Grant Number
H80CS29834
Participating Start Date
10/1/2018
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
10/9/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/25/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jennifer Henry, Promise Healthcare Executive Director
(217) 403-5401
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/9/2023
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