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WAL-MART PHARMACY 10-2035
CH05064C Family Health Services of Darke County
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Covered Entity Details
Entity Name
Family Health Services of Darke County
Subdivision Name
New Madison Medical Center
Type
HRSA-Funded Health Center
340B ID
CH05064C
Entity Address
101 ANDERSON ST
NEW MADISON, OH 45346-9715
Grant Number
H80CS00419
Participating Start Date
4/1/2015
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2035
Pharmacy Address
1501 WAGNER AVE
GREENVILLE, OH 45331
Pharmacy Comments
Contract Details
Approval Date
10/13/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jared Pollick, Executive Director
(937) 548-3806
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/13/2023
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