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Walmart Pharmacy 10-7611
CH031600 TRI-STATE COMMUNITY HEALTH CENTER
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Covered Entity Details
Entity Name
TRI-STATE COMMUNITY HEALTH CENTER
Subdivision Name
TRI-STATE COMMUNITY HEALTH CENTER, INC.
Type
HRSA-Funded Health Center
340B ID
CH031600
Entity Address
130 W High St
Hancock, MD 21750-1143
Grant Number
H80CS00069
Participating Start Date
12/1/1992
Last Recertification Date
3/10/2025
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
SHEILA DESHONG, COO
(301) 678-5187 Ext: 226
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
10/16/2023
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