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Walmart Pharmacy 10-7611
CH04550T PREMIER COMMUNITY HEALTHCARE GROUP INC
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Covered Entity Details
Entity Name
PREMIER COMMUNITY HEALTHCARE GROUP INC
Subdivision Name
Premier Community HealthCare Group Inc. - Hudson High
Type
HRSA-Funded Health Center
340B ID
CH04550T
Entity Address
14410 Cobra Way
Hudson, FL 34669-1011
Grant Number
H80CS00101
Participating Start Date
4/1/2024
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
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
Joseph Resnick, CEO
(352) 518-2000 Ext: 9000
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
4/9/2024
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