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WALMART PHARMACY 10-5169
CH04522A RURAL HEALTH SERVICES INC
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Covered Entity Details
Entity Name
RURAL HEALTH SERVICES INC
Subdivision Name
Clyburn Center for Primary Care
Type
HRSA-Funded Health Center
340B ID
CH04522A
Entity Address
1000 Clyburn Place
Aiken, SC 29801
Grant Number
H80CS00653
Participating Start Date
1/1/2010
Last Recertification Date
2/24/2025
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
10/13/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Carolyn Emanuel-McClain, CEO
(803) 380-7012
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
10/13/2023
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