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WAL-MART PHARMACY 10-0250
CH071496M REGIONAL HEALTH CARE CLINIC, INC.
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Covered Entity Details
Entity Name
REGIONAL HEALTH CARE CLINIC, INC.
Subdivision Name
Katy on the Trail
Type
HRSA-Funded Health Center
340B ID
CH071496M
Entity Address
821 Westwood Dr
Sedalia, MO 65301-2102
Grant Number
H80CS06668
Participating Start Date
7/1/2024
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0250
Pharmacy Address
103 W POLK ST
WARSAW, MO 65355
Pharmacy Comments
Contract Details
Approval Date
6/6/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael Waller, CEO
(208) 800-8676
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/12/2024
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