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WALMART PHARMACY 10-5169
CH04550U 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. - Gulfside Elementary School
Type
HRSA-Funded Health Center
340B ID
CH04550U
Entity Address
2329 Anclote Blvd
Holiday, FL 34691-9739
Grant Number
H80CS00101
Participating Start Date
7/1/2024
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
4/15/2024
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
4/12/2024
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