Contract Pharmacy Details

WALMART PHARMACY #10-5005
CH042063A SULZBACHER, I M CENTER FOR THE HOMELESS INC, THE

Covered Entity Details

Entity Name

SULZBACHER, I M CENTER FOR THE HOMELESS INC, THE

Subdivision Name

Beaches Community Healthcare - A Sulzbacher Center Clinic

Type

HRSA-Funded Health Center

340B ID

CH042063A

Entity Address

850 Sixth Avenue STE 500
Jacksonville Beach, FL 32250

Grant Number

H80CS00305

Participating Start Date

1/1/2016

Last Recertification Date

2/13/2025

Pharmacy Details

Pharmacy Name

WALMART PHARMACY #10-5005

Pharmacy Address

6855 WILSON BOULEVARD
JACKSONVILLE, FL 32210

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

Cindy Funkhouser, CEO
(904) 394-8069

Contract Pharmacy Representative

Walmart
Van Donn, Director of Contracting 340b
(303) 261-5549

Signed By Date

10/16/2023

340B Drug Pricing Program Database