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Walmart Pharmacy 10-7611
CHC28971-02 Panhandle Counseling and Health Center, Inc.
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Covered Entity Details
Entity Name
Panhandle Counseling and Health Center, Inc.
Subdivision Name
Panhandle Counseling and Health Center Outreach Center
Type
HRSA-Funded Health Center
340B ID
CHC28971-02
Entity Address
1309 N East St
Guymon, OK 73942-3333
Grant Number
H80CS28971
Participating Start Date
1/1/2020
Last Recertification Date
2/17/2025
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
Sarah Wagner, CEO
(580) 338-0072
Contract Pharmacy Representative
Walmart
Julie Howard, 340b Program Manager
(479) 739-1973 Ext: 4792771498
Signed By Date
10/11/2023
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