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Walmart Pharmacy 10-7611
CHC24163-02 East Hill Family Medical Inc
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Covered Entity Details
Entity Name
East Hill Family Medical Inc
Subdivision Name
EHMC Dental
Type
HRSA-Funded Health Center
340B ID
CHC24163-02
Entity Address
144 Genesee St
303
Auburn, NY 13021-3526
Grant Number
H80CS24163
Participating Start Date
4/1/2023
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
4/10/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
April Miles, President & CEO
(315) 612-3465 Ext: 3465
Contract Pharmacy Representative
Walmart
Van Donn, Director of Contracting 340b
(303) 261-5549
Signed By Date
4/10/2024
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