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Walmart Pharmacy 10-7611
CH0611930 KIAMICHI FAMILY MEDICAL CENTER
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Covered Entity Details
Entity Name
KIAMICHI FAMILY MEDICAL CENTER
Subdivision Name
Type
HRSA-Funded Health Center
340B ID
CH0611930
Entity Address
6026 BATTIEST PICKENS RD
BROKEN BOW, OK 74728-5037
Grant Number
H80CS00267
Participating Start Date
1/1/2003
Last Recertification Date
2/10/2025
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
Amy Gilbreath, CEO
(580) 286-6688
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
10/13/2023
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