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WAL-MART PHARMACY 10-2237
CH04168Y FAMILY HEALTH CENTERS OF SOUTHWEST FLORIDA, INC.
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Covered Entity Details
Entity Name
FAMILY HEALTH CENTERS OF SOUTHWEST FLORIDA, INC.
Subdivision Name
Port Charlotte Family Practice Medical Office
Type
HRSA-Funded Health Center
340B ID
CH04168Y
Entity Address
4300 Kings Hwy
Ste 210
Port Charlotte, FL 33980-2922
Grant Number
H80CS00185
Participating Start Date
1/1/2015
Last Recertification Date
3/5/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2237
Pharmacy Address
2523 LEE BLVD
LEHIGH ACRES, FL 33971
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
Carrie Poulsom, VP & Chief Pharmacy Officer
(239) 344-2321
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
1/16/2024
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