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WAL-MART PHARMACY 10-1731
CH02821R FINGER LAKES MIGRANT HEALTH CARE
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Covered Entity Details
Entity Name
FINGER LAKES MIGRANT HEALTH CARE
Subdivision Name
Mobile Medical Van
Type
HRSA-Funded Health Center
340B ID
CH02821R
Entity Address
14 Maiden Ln
Penn Yan, NY 14527-1208
Grant Number
H80CS00849
Participating Start Date
4/1/2015
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1731
Pharmacy Address
990 RT 5 & 20
GENEVA, NY 14456
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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