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Walmart Pharmacy 10-7611
CH039840 WALNUT STREET COMMUNITY HEALTH CENTER
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Covered Entity Details
Entity Name
WALNUT STREET COMMUNITY HEALTH CENTER
Subdivision Name
Walnut Street Community Heath Center, Inc. DBA: FAMILY HEALTHCARE OF HAGERSTOWN
Type
HRSA-Funded Health Center
340B ID
CH039840
Entity Address
201 South Cleveland Avenue
HAGERSTOWN, MD 21740-4738
Grant Number
H80CS00857
Participating Start Date
10/1/2003
Last Recertification Date
2/27/2025
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
Contacts
Covered Entity Signing Official
David F. Becker, CFO
(301) 745-3777 Ext: 1080
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
10/9/2023
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