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Walmart Pharmacy 10-7611
CH10076H NORTHWEST HUMAN SERVICES, INC.
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Covered Entity Details
Entity Name
NORTHWEST HUMAN SERVICES, INC.
Subdivision Name
TOTAL HEALTH COMMUNIITY CLINIC
Type
HRSA-Funded Health Center
340B ID
CH10076H
Entity Address
180 ATWATER STREET, N
MONMOUTH, OR 97361
Grant Number
H80CS00148
Participating Start Date
10/1/2004
Last Recertification Date
2/14/2025
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
PAUL LOGAN, CEO
(503) 588-5828 Ext: 831
Contract Pharmacy Representative
Welllpartner
Kristen Hartlen, Sr. Account Manager
(480) 364-2573
Signed By Date
10/16/2023
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