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Walmart Pharmacy 10-7611
CH05220AE DOWNRIVER COMMUNITY SERVICES INC
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Covered Entity Details
Entity Name
DOWNRIVER COMMUNITY SERVICES INC
Subdivision Name
DCS NEW HAVEN COMMUNITY SERVICES
Type
HRSA-Funded Health Center
340B ID
CH05220AE
Entity Address
58144 GRATIOT AVE
NEW HAVEN, MI 48048
Grant Number
H80CS00497
Participating Start Date
7/1/2006
Last Recertification Date
2/18/2025
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
Mike Baranowski, CEO
(586) 270-8055
Contract Pharmacy Representative
Walmart
Van Donn, 340B Director Contracting
(479) 273-4000
Signed By Date
10/11/2023
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