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WAL-MART PHARMACY 10-2238
CH05102D HACKLEY COMMUNITY CARE CENTER INC
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Covered Entity Details
Entity Name
HACKLEY COMMUNITY CARE CENTER INC
Subdivision Name
Oakridge Teen Health Center
Type
HRSA-Funded Health Center
340B ID
CH05102D
Entity Address
251 S Wolf Lake Rd
Muskegon, MI 49442
Grant Number
H80CS00684
Participating Start Date
1/1/2017
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2238
Pharmacy Address
1879 E SHERMAN BLVD
MUSKEGON, MI 49444
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
Valerie J Blondin, CFO
(231) 733-6657
Contract Pharmacy Representative
Walmart
Van Donn, Director of Contracting 340b
(303) 261-5549
Signed By Date
10/12/2023
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