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Walmart Pharmacy 10-7611
CH0420630 I.M. SULZBACHER CENTER FOR THE HOMELESS
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Covered Entity Details
Entity Name
I.M. SULZBACHER CENTER FOR THE HOMELESS
Subdivision Name
Type
HRSA-Funded Health Center
340B ID
CH0420630
Entity Address
611 EAST ADAMS STREET
JACKSONVILLE, FL 32202
Grant Number
H80CS00305
Participating Start Date
7/1/2002
Last Recertification Date
2/13/2025
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
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
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