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WALMART PHARMACY 10-5169
FQHCLA419 Centerstone Health Services, Inc.
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Covered Entity Details
Entity Name
Centerstone Health Services, Inc.
Subdivision Name
Centerstone Health Services - Connersville
Type
Health Center Program Look-Alike
340B ID
FQHCLA419
Entity Address
390 Erie Ave
Connersville, IN 47331-3177
Grant Number
LALCS40181
Participating Start Date
4/1/2021
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-5169
Pharmacy Address
2252 NORTH 8TH STREET
SUITE A
ROGERS, AR 72756
Pharmacy Comments
Contract Details
Approval Date
4/9/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jennifer Harrison, CEO
(812) 350-8249
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/9/2024
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