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WALMART PHARMACY 10-5169
CHC00333-00 CITIZENS OF LAKE COUNTY FOR HEALTH CARE
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Covered Entity Details
Entity Name
CITIZENS OF LAKE COUNTY FOR HEALTH CARE
Subdivision Name
Lake County Primary Care Clinic
Type
HRSA-Funded Health Center
340B ID
CHC00333-00
Entity Address
710 Carl Perkins Parkway
TIPTONVILLE, TN 38079
Grant Number
H80CS00333
Participating Start Date
10/1/2010
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-5169
Pharmacy Address
2252 NORTH 8TH STREET
SUITE A
ROGERS, AR 72756
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
GAYANNE WILLIAMS, EXECUTIVE DIRECTOR
(731) 253-6690
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
1/11/2024
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