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Walmart Pharmacy 10-7611
CH077310 COMMUNITY HEALTH CENTERS OF SOUTHEASTERN IOWA, INC
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Covered Entity Details
Entity Name
COMMUNITY HEALTH CENTERS OF SOUTHEASTERN IOWA, INC
Subdivision Name
CHC/SEIA WEST BURLINGTON CLINIC
Type
HRSA-Funded Health Center
340B ID
CH077310
Entity Address
1706 W Agency Rd
West Burlington, IA 52655-1667
Grant Number
H80CS00272
Participating Start Date
1/1/2003
Last Recertification Date
2/17/2025
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
Antonio Flores, CEO
(319) 753-2300 Ext: 122
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/16/2023
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