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WAL-MART PHARMACY 10-0645
CHC10590-05 MIDTOWN HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
MIDTOWN HEALTH CENTER, INC.
Subdivision Name
Midtown Health Center - Wayne State College
Type
HRSA-Funded Health Center
340B ID
CHC10590-05
Entity Address
1200 Providence Rd
Wayne, NE 68787
Grant Number
H80CS10590
Participating Start Date
4/1/2021
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0645
Pharmacy Address
2400 PASEWALK AVE
NORFOLK, NE 68701
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
KATHY NORDBY, Cheif Executive Officer
(402) 370-1060
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/16/2023
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