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Walmart Pharmacy 10-7611
SCH450241-00 FAITH COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
FAITH COMMUNITY HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH450241-00
Entity Address
215 Chisholm Trail
JACKSBORO, TX 76458
Medicare Provider Number
450241
Participating Start Date
1/1/2017
Last Recertification Date
8/23/2024
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
Kim Lee, COO
(940) 216-2225
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/5/2024
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