340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WALMART PHARMACY 10-5169
FQHCLA443A SPACE COAST HEALTH CENTERS INC
Print
Covered Entity Details
Entity Name
SPACE COAST HEALTH CENTERS INC
Subdivision Name
Space Coast Health Centers Primary Care - Port St. John
Type
Health Center Program Look-Alike
340B ID
FQHCLA443A
Entity Address
5005 Port St John Pkwy Ste 2400
Cocoa, FL 32927-4305
Grant Number
LALCS45787
Participating Start Date
4/1/2023
Last Recertification Date
2/21/2025
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
1/15/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Arvin H Lewis, CEO
(321) 346-8031
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/15/2024
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session