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Walmart Pharmacy 10-7611
CH020870 NORTHERN OSWEGO COUNTY HEALTH SERVICES, INC
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Covered Entity Details
Entity Name
NORTHERN OSWEGO COUNTY HEALTH SERVICES, INC
Subdivision Name
NORTHERN OSWEGO COUNTY HEALTH SERVICES, INC.
Type
HRSA-Funded Health Center
340B ID
CH020870
Entity Address
61 Delano St
Pulaski, NY 13142-1400
Grant Number
H80CS00166
Participating Start Date
10/1/2004
Last Recertification Date
2/11/2025
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
Tracy L Wimmer, VP/Chief Financial Officer
(315) 298-6569 Ext: 2020
Contract Pharmacy Representative
Hudson
Kimberly Barron, TPA
(518) 217-3887
Signed By Date
10/16/2023
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