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WAL-MART CENTRAL FILL 10-2670
CH01098G AMMONOOSUC COMMUNITY HEALTH SERVICES INC
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Covered Entity Details
Entity Name
AMMONOOSUC COMMUNITY HEALTH SERVICES INC
Subdivision Name
ACHS - Franconia Alpine
Type
HRSA-Funded Health Center
340B ID
CH01098G
Entity Address
1095 Profile Road
B
Franconia, NH 03580
Grant Number
H80CS00554
Participating Start Date
4/1/2018
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
WAL-MART CENTRAL FILL 10-2670
Pharmacy Address
608 SPRING HILL DR # 3 SUITE 300
SPRING, TX 77386
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
EDWARD D. SHANSHALA II, CEO
(603) 444-8223
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
4/3/2024
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