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WALMART PHARMACY 10-5169
CH04550E PREMIER COMMUNITY HEALTHCARE GROUP, INC.
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Covered Entity Details
Entity Name
PREMIER COMMUNITY HEALTHCARE GROUP, INC.
Subdivision Name
Dade City Family Health Center
Type
HRSA-Funded Health Center
340B ID
CH04550E
Entity Address
14027 5TH STREET
DADE CITY, FL 33525
Grant Number
H80CS00101
Participating Start Date
4/1/1998
Last Recertification Date
2/14/2025
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
Joseph Resnick, CEO
(352) 518-2000 Ext: 9000
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
10/13/2023
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