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WAL-MART PHARMACY 10-2480
CHC08760-19 WAYNE MEMORIAL COMMUNITY HEALTH CENTERS
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Covered Entity Details
Entity Name
WAYNE MEMORIAL COMMUNITY HEALTH CENTERS
Subdivision Name
Lake Region Urgent Care
Type
HRSA-Funded Health Center
340B ID
CHC08760-19
Entity Address
273 Grandview Ave
Honesdale, PA 18431-1163
Grant Number
H80CS08760
Participating Start Date
1/1/2021
Last Recertification Date
2/24/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2480
Pharmacy Address
723A OLD WILLOW AVE
HONESDALE, PA 18431
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
Robert J. Fortuner II, Finance Director
(570) 253-8337
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
10/13/2023
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