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WAL-MART PHARMACY 10-0014
CH07720AH ADVOCATES FOR A HEALTHY COMMUNITY INC
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Covered Entity Details
Entity Name
ADVOCATES FOR A HEALTHY COMMUNITY INC
Subdivision Name
Jordan Valley Community Health Center - Lebanon
Type
HRSA-Funded Health Center
340B ID
CH07720AH
Entity Address
860 Lynn St
Lebanon, MO 65536-3832
Grant Number
H80CS00275
Participating Start Date
7/1/2017
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0014
Pharmacy Address
1800 S JEFFERSON AVE
LEBANON, MO 65536
Pharmacy Comments
Contract Details
Approval Date
1/16/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ryan Kruger, VP PACE/Pharmacy
(417) 851-1551
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/16/2024
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