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Walmart Pharmacy 10-7611
CHC31892-06 CENTERPLACE HEALTH INC
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Covered Entity Details
Entity Name
CENTERPLACE HEALTH INC
Subdivision Name
North Port Behavioral Health Services Center
Type
HRSA-Funded Health Center
340B ID
CHC31892-06
Entity Address
6919 Outreach Way
North Port, FL 34287-3493
Grant Number
H80CS31892
Participating Start Date
10/1/2023
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
1/5/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kari Aud Ellingstad, CEO
(941) 529-2422
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
1/5/2024
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