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WAL-MART PHARMACY 10-0708
CH04842A Claiborne County Family Health Center
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Covered Entity Details
Entity Name
Claiborne County Family Health Center
Subdivision Name
PORT GIBSON MIDDLE BASE CLINIC
Type
HRSA-Funded Health Center
340B ID
CH04842A
Entity Address
161 Ramsey Dr
Port Gibson, MS 39150-2531
Grant Number
H80CS00482
Participating Start Date
1/1/2022
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0708
Pharmacy Address
2150 IOWA AVENUE
VICKSBURG, MS 39180
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
LaDonna Davis, COO
(601) 437-3052 Ext: 6014373050
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/16/2023
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