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Walmart Pharmacy 10-7611
CH040600 MOUNTAIN COMPREHENSIVE HEALTH CORPORATION
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Covered Entity Details
Entity Name
MOUNTAIN COMPREHENSIVE HEALTH CORPORATION
Subdivision Name
Whitesburg Medical/Dental Clinic
Type
HRSA-Funded Health Center
340B ID
CH040600
Entity Address
226 Medical Plaza Ln
Whitesburg, KY 41858-7425
Grant Number
H80CS00367
Participating Start Date
10/1/2004
Last Recertification Date
2/24/2025
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
10/17/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
L.M. Caudill, CEO
(606) 633-4823
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
10/17/2023
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