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WAL-MART PHARMACY 10-1486
CH03070AD Central Virginia Health Services, Inc.
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Covered Entity Details
Entity Name
Central Virginia Health Services, Inc.
Subdivision Name
CVHS - Petersburg Recovery Center
Type
HRSA-Funded Health Center
340B ID
CH03070AD
Entity Address
541 S. Sycamore St
Petersburg, VA 23803
Grant Number
H80CS00479
Participating Start Date
10/1/2022
Last Recertification Date
2/28/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1486
Pharmacy Address
1800 PERRY DR
FARMVILLE, VA 23901
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
Paula Anne Tomko, Chief Executive Officer
(434) 581-3276
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
10/17/2023
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