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WAL-MART PHARMACY 10-1792
CH03230J KEYSTONE RURAL HEALTH CONSORTIA INC
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Covered Entity Details
Entity Name
KEYSTONE RURAL HEALTH CONSORTIA INC
Subdivision Name
Fox Township Dental Clinic
Type
HRSA-Funded Health Center
340B ID
CH03230J
Entity Address
176 Skyline Drive
Kersey, PA 15846
Grant Number
H80CS00688
Participating Start Date
10/1/2017
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1792
Pharmacy Address
1102 MILLION DOLLAR HIGHWAY
ST MARY'S, PA 15857
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
Kristie Bennardi, CEO
(814) 486-1115
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
10/16/2023
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