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Walmart Pharmacy 10-7611
CH01347C SAINT CROIX REGIONAL FAMILY HEALTH CENTER
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Covered Entity Details
Entity Name
SAINT CROIX REGIONAL FAMILY HEALTH CENTER
Subdivision Name
Temporary Site- Calais Blue Devil Health
Type
HRSA-Funded Health Center
340B ID
CH01347C
Entity Address
35 Blue Devil Hill
Calais, ME 04619
Grant Number
H80CS00526
Participating Start Date
4/1/2022
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
10/16/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Corinne A. LaPlant, CEO
(207) 796-5503
Contract Pharmacy Representative
Walmart
Van Donn, 340B Director Contracting
(479) 273-4000
Signed By Date
10/16/2023
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