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WAL-MART PHARMACY 10-1338
CH04813E VALLEY HEALTHCARE SYSTEM, INC.
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Covered Entity Details
Entity Name
VALLEY HEALTHCARE SYSTEM, INC.
Subdivision Name
VHcS Fortson Medical/Dental Center
Type
HRSA-Funded Health Center
340B ID
CH04813E
Entity Address
94 Mccrary Rd
Fortson, GA 31808-4558
Grant Number
H80CS00678
Participating Start Date
10/1/2009
Last Recertification Date
3/3/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1338
Pharmacy Address
3515 VICTORY DRIVE
COLUMBUS, GA 31903
Pharmacy Comments
Contract Details
Approval Date
1/9/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Asante Hilts, CEO
(706) 987-8343
Contract Pharmacy Representative
Walmart
Julie Howard, 340b Program Manager
(479) 739-1973 Ext: 4792771498
Signed By Date
1/9/2024
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