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WAL-MART PHARMACY 10-5471
CH05711C THIRD STREET COMMUNITY CLINIC
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Covered Entity Details
Entity Name
THIRD STREET COMMUNITY CLINIC
Subdivision Name
Hawkins Medical Center
Type
HRSA-Funded Health Center
340B ID
CH05711C
Entity Address
2131 Park Avenue West
STE 200
Ontario, OH 44906
Grant Number
H80CS00581
Participating Start Date
10/1/2013
Last Recertification Date
2/27/2025
Entity Termination Date
7/1/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5471
Pharmacy Address
2485 POSSUM RUN ROAD
MANSFIELD (S), OH 44903
Pharmacy Comments
Contract Details
Approval Date
1/11/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2025
Covered Entity Terminated
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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