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WAL-MART PHARMACY 10-1618
FQHCLA391 219 HEALTH NETWORK INC
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Covered Entity Details
Entity Name
219 HEALTH NETWORK INC
Subdivision Name
219 Health Network
Type
Health Center Program Look-Alike
340B ID
FQHCLA391
Entity Address
100 W. Chicago Ave. STE F
East Chicago, IN 46312
Grant Number
LALCS32751
Participating Start Date
10/1/2019
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1618
Pharmacy Address
2936 E. 79TH AVE
MERRILLVILLE, IN 46410
Pharmacy Comments
Contract Details
Approval Date
1/15/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Patricia A Johnson, CEO
(219) 703-2585
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/15/2024
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