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Walmart Pharmacy 10-7611
CH084100 HIGH PLAINS COMMUNITY HEALTH CENTER
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Covered Entity Details
Entity Name
HIGH PLAINS COMMUNITY HEALTH CENTER
Subdivision Name
HIGH PLAINS COMMUNITY HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH084100
Entity Address
201 Kendall Dr
Lamar, CO 81052-3939
Grant Number
H80CS00214
Participating Start Date
7/1/1997
Last Recertification Date
2/25/2025
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
10/11/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Gene Sobczak, Interim CEO
(719) 336-0261
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
10/11/2023
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