340B Drug Pricing Program Database
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Walmart Pharmacy 10-7611
CH045780 AMITE COUNTY MEDICAL SERVICES, INC.
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Covered Entity Details
Entity Name
AMITE COUNTY MEDICAL SERVICES, INC.
Subdivision Name
AMITE COUNTY MEDICAL SERVICES, INC.
Type
HRSA-Funded Health Center
340B ID
CH045780
Entity Address
102 WEST FREEDOM DRIVE
LIBERTY, MS 39645-0511
Grant Number
H80CS00609
Participating Start Date
7/1/2002
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
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
Baili Harvey, Finance Director
(601) 657-4326
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/3/2024
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