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WAL-MART PHARMACY 10-1813
CH02821P FINGER LAKES MIGRANT HEALTH CARE
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Covered Entity Details
Entity Name
FINGER LAKES MIGRANT HEALTH CARE
Subdivision Name
Dundee Dental Center
Type
HRSA-Funded Health Center
340B ID
CH02821P
Entity Address
6 Stoll St
Dundee, NY 14837-1013
Grant Number
H80CS00849
Participating Start Date
4/1/2015
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1813
Pharmacy Address
6788 ROUTE 31 EAST
VILLAGE OF NEWARK, NY 14513
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
Mary A Zelazny, CEO
(315) 531-9102
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
1/16/2024
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