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Walmart Pharmacy 10-7611
CHC330723-00 UNIVERSITY OF WYOMING
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Covered Entity Details
Entity Name
UNIVERSITY OF WYOMING
Subdivision Name
University of Wyoming Family Medicine Residency Casper
Type
HRSA-Funded Health Center
340B ID
CHC330723-00
Entity Address
1522 E A St
Casper, WY 82601-2217
Grant Number
H80CS30723
Participating Start Date
10/1/2017
Last Recertification Date
3/10/2025
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
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
Farrell J Rapp, Director Research Services
(307) 766-5320
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
10/12/2023
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