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Walmart Pharmacy 10-7611
CH034190 MINNIE HAMILTON HEALTH CARE CENTER
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Covered Entity Details
Entity Name
MINNIE HAMILTON HEALTH CARE CENTER
Subdivision Name
MINNIE HAMILTON HEALTH CARE CENTER
Type
HRSA-Funded Health Center
340B ID
CH034190
Entity Address
186 Hospital Dr
Grantsville, WV 26147-7100
Grant Number
H80CS00761
Participating Start Date
1/1/2004
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
Stephen Whited, CEO
(304) 354-9244 Ext: 5183
Contract Pharmacy Representative
Walmart
Van Donn, Director of Contracting
(479) 277-3719
Signed By Date
10/16/2023
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