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WAL-MART PHARMACY 10-0767
CH04271F TRENTON MEDICAL CENTER
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Covered Entity Details
Entity Name
TRENTON MEDICAL CENTER
Subdivision Name
Palms Medical Group - Branford
Type
HRSA-Funded Health Center
340B ID
CH04271F
Entity Address
103 US Hwy 27 SW
Branford, FL 32008-3048
Grant Number
H80CS00691
Participating Start Date
1/1/2010
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0767
Pharmacy Address
2767 WEST US HIGHWAY 90
LAKE CITY, FL 32055
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
Anita Rembert, CEO
(352) 463-4501
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
1/16/2024
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