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WAL-MART PHARMACY 10-1962
CH05311W INDIANA HEALTH CENTERS INCORPORATED
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Covered Entity Details
Entity Name
INDIANA HEALTH CENTERS INCORPORATED
Subdivision Name
HealthQuest Van
Type
HRSA-Funded Health Center
340B ID
CH05311W
Entity Address
HEALTHQUEST VAN 925 SOUTH
MARION, IN 46952-3849
Grant Number
H80CS00668
Participating Start Date
7/1/2017
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1962
Pharmacy Address
1920 E. MARKLAND AVE
KOKOMO, IN 46901
Pharmacy Comments
Contract Details
Approval Date
4/3/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Nicole Meyer, COO
(317) 576-1335 Ext: 4137
Contract Pharmacy Representative
Walmart
Julie Howard, 340b Program Manager
(479) 739-1973 Ext: 4792771498
Signed By Date
4/3/2024
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