Contract Pharmacy Details

WAL-MART PHARMACY 10-1305
CH059030 COMMUNITY HEALTH SYSTEMS, INC.

Covered Entity Details

Entity Name

COMMUNITY HEALTH SYSTEMS, INC.

Subdivision Name

Corporate Office

Type

HRSA-Funded Health Center

340B ID

CH059030

Entity Address

74 Eclipse Ctr
BELOIT, WI 53511-3550

Grant Number

H80CS00676

Participating Start Date

1/1/1999

Last Recertification Date

2/14/2025

Pharmacy Details

Pharmacy Name

WAL-MART PHARMACY 10-1305

Pharmacy Address

3800 DEERFIELD DR
JANESVILLE, WI 53545

Pharmacy Comments

Contract Details

Approval Date

4/9/2024

Contract Begin Date

7/1/2024

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/9/2024
Agreement registered in error

Contacts

Covered Entity Signing Official

Caryn Davis, Director of Finance
(608) 299-3302

Contract Pharmacy Representative

Community Health Systems, Inc.
Angelique Ayers, Specialized Services Coordinator
(608) 299-3303

Signed By Date

4/9/2024

340B Drug Pricing Program Database