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WALMART PHARMACY 10-5169
RRC230037-00 Hillsdale Community Health Center
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Covered Entity Details
Entity Name
Hillsdale Community Health Center
Subdivision Name
Hillsdale Hospital
Type
Rural Referral Center
340B ID
RRC230037-00
Entity Address
168 S. Howell Street
Hillsdale, MI 49242
Medicare Provider Number
230037
Participating Start Date
7/1/2012
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-5169
Pharmacy Address
2252 NORTH 8TH STREET
SUITE A
ROGERS, AR 72756
Pharmacy Comments
Contract Details
Approval Date
10/12/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mark Gross, CFO
(517) 437-5232
Contract Pharmacy Representative
Hillsdale Hospital
Jeff Kauffman, Director of Pharmacy
(517) 437-5239
Signed By Date
10/12/2023
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