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WAL-MART PHARMACY 10-5172
STD323011 big bend cares
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Covered Entity Details
Entity Name
big bend cares
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD323011
Entity Address
2200 S Monroe St
Tallahassee, FL 32301
Grant Number
6 NH25PS005131-05-04
Participating Start Date
1/1/2017
Last Recertification Date
5/13/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5172
Pharmacy Address
1900 SOUTH JEFFERSON ST
PERRY, FL 32348
Pharmacy Comments
Contract Details
Approval Date
4/1/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Robert Renzi, CEO
(850) 656-2437 Ext: 240
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/1/2024
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