Contract Pharmacy Details

Walmart Pharmacy 10-7611
FQHC638398 JAMESTOWN S'KLALLAM TRIBE

Covered Entity Details

Entity Name

JAMESTOWN S'KLALLAM TRIBE

Subdivision Name

Jamestown Family Health Clinic

Type

Tribal Contract/Compact with IHS (P.L. 93-638)

340B ID

FQHC638398

Entity Address

808 N. 5th Avenue
SEQUIM, WA 98382

Grant Number

Participating Start Date

1/1/2001

Last Recertification Date

3/5/2025

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

Brent D. Simcosky, Director of Health Services
(360) 582-4870

Contract Pharmacy Representative

Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498

Signed By Date

1/5/2024

340B Drug Pricing Program Database