Contract Pharmacy Details

WALMART PHARMACY 10-7221
CHC31892-04 Centerplace Health, Inc.

Covered Entity Details

Entity Name

Centerplace Health, Inc.

Subdivision Name

Venice Family Services

Type

HRSA-Funded Health Center

340B ID

CHC31892-04

Entity Address

2350 Scenic Dr
Venice, FL 34293-1510

Grant Number

H80CS31892

Participating Start Date

4/1/2021

Last Recertification Date

1/31/2024

Entity Termination Date

4/1/2025

Pharmacy Details

Pharmacy Name

WALMART PHARMACY 10-7221

Pharmacy Address

1100 S MAIN STREET
NORTH PORT, FL 34287

Pharmacy Comments

Contract Details

Approval Date

1/5/2024

Contract Begin Date

4/1/2024

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2025
Covered Entity Terminated

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

340B Drug Pricing Program Database