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Walmart Pharmacy 10-7611
CH01517C SEBASTICOOK FAMILY DOCTORS
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Covered Entity Details
Entity Name
SEBASTICOOK FAMILY DOCTORS
Subdivision Name
FAMILY DOCTORS - DEXTER
Type
HRSA-Funded Health Center
340B ID
CH01517C
Entity Address
29 Church St
Dexter, ME 04930-1320
Grant Number
H80CS02448
Participating Start Date
7/1/2005
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
10/15/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Robin Winslow, CEO
(207) 368-4213
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
10/15/2023
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