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Walmart Pharmacy 10-7611
CH04392D Mantachie Rural Health Care Inc
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Covered Entity Details
Entity Name
Mantachie Rural Health Care Inc
Subdivision Name
Mantachie Rural Health Care, Inc. School Based Clinic
Type
HRSA-Funded Health Center
340B ID
CH04392D
Entity Address
311 Mustang Dr
Mantachie, MS 38855
Grant Number
H80CS00096
Participating Start Date
7/1/2022
Last Recertification Date
2/24/2025
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
james h jackson jr, CEO
(662) 282-4229
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
10/9/2023
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