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WAL-MART PHARMACY 10-1539
CH05711A THIRD STREET COMMUNITY CLINIC
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Covered Entity Details
Entity Name
THIRD STREET COMMUNITY CLINIC
Subdivision Name
Cornerstone OB/GYN
Type
HRSA-Funded Health Center
340B ID
CH05711A
Entity Address
770 Balgreen Dr
207
Mansfield, OH 44906-4106
Grant Number
H80CS00581
Participating Start Date
10/1/2010
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1539
Pharmacy Address
359 LEXINGTON SPRINGMILL
MANSFIELD, OH 44906
Pharmacy Comments
Contract Details
Approval Date
1/11/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Peggy Anderson, CEO
(419) 526-7880
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
1/11/2024
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