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Walmart Pharmacy 10-7611
CHC12886-00 LOWER LIGHTS CHRISTIAN HEALTH CENTER INC
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Covered Entity Details
Entity Name
LOWER LIGHTS CHRISTIAN HEALTH CENTER INC
Subdivision Name
Lower Lights Christian Health Center
Type
HRSA-Funded Health Center
340B ID
CHC12886-00
Entity Address
1160 W Broad St
Columbus, OH 43222-1317
Grant Number
H80CS12886
Participating Start Date
1/1/2011
Last Recertification Date
2/13/2025
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
6/26/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Tracy Cloud, CEO
(614) 274-1455 Ext: 6000
Contract Pharmacy Representative
Walmart
Van Donn, Director of Contracting 340b
(303) 261-5549
Signed By Date
10/9/2023
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