Contract Pharmacy Details

WAL-MART PHARMACY 10-5315
CH040650 PARK DUVALLE COMMUNITY HEALTH CENTER, INC.

Covered Entity Details

Entity Name

PARK DUVALLE COMMUNITY HEALTH CENTER, INC.

Subdivision Name

Park DuValle Community Health Center, Inc.

Type

HRSA-Funded Health Center

340B ID

CH040650

Entity Address

3015 Wilson Ave
Louisville, KY 40211-1969

Grant Number

H80CS00083

Participating Start Date

12/1/1992

Last Recertification Date

2/12/2025

Pharmacy Details

Pharmacy Name

WAL-MART PHARMACY 10-5315

Pharmacy Address

2354 COMMERCE PARK DR.
ORLANDO, FL 32819

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

Swannie Jett, CEO
(502) 774-4401

Contract Pharmacy Representative

Walmart
Julie Howard, 340B Program Manager
(479) 277-1498

Signed By Date

10/16/2023

340B Drug Pricing Program Database