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WAL-MART PHARMACY 10-1733
CH05036Z Great Lakes Bay Health Centers
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Covered Entity Details
Entity Name
Great Lakes Bay Health Centers
Subdivision Name
Great Lakes Bay Health Centers Shiawassee
Type
HRSA-Funded Health Center
340B ID
CH05036Z
Entity Address
200 N Caledonia Dr
Owosso, MI 48867
Grant Number
H80CS00689
Participating Start Date
7/1/2014
Last Recertification Date
2/27/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1733
Pharmacy Address
1621 EAST M-21
OWOSSO, MI 48867
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 Colleen Evans, CFO
(989) 759-6438
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/13/2023
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