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Walmart Pharmacy 10-7611
CH101610 GLENNS FERRY HEALTH CENTER, Inc.
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Covered Entity Details
Entity Name
GLENNS FERRY HEALTH CENTER, Inc.
Subdivision Name
DESERT SAGE HEALTH CENTERS
Type
HRSA-Funded Health Center
340B ID
CH101610
Entity Address
486 W. FIRST AVE.
GLENNS FERRY, ID 83623
Grant Number
H80CS00473
Participating Start Date
10/1/1998
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
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
Mary Ferguson Ferguson, CEO
(208) 696-7216
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
10/13/2023
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