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WAL-MART PHARMACY 10-3406
STD760151 CAN Community Health, Inc.
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Covered Entity Details
Entity Name
CAN Community Health, Inc.
Subdivision Name
Arlington
Type
Sexually Transmitted Diseases
340B ID
STD760151
Entity Address
601 Matlock Centre Circle
Arlington, TX 76015
Grant Number
NU62PS924644
Participating Start Date
2/1/2023
Last Recertification Date
5/28/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-3406
Pharmacy Address
15220 MONTFORT DRIVE
DALLAS(PRESTWOOD), TX 75248
Pharmacy Comments
Contract Details
Approval Date
1/18/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Rishi Patel, President & CEO
(941) 300-4440 Ext: 11127
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
1/18/2024
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