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WAL-MART PHARMACY 10-0796
CH05006X COMMUNITY HEALTH PARTNERSHIP OF ILLINOIS
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Covered Entity Details
Entity Name
COMMUNITY HEALTH PARTNERSHIP OF ILLINOIS
Subdivision Name
CHP Harvard Dental Clinic
Type
HRSA-Funded Health Center
340B ID
CH05006X
Entity Address
62 N Ayer Street, Suites C & D
Harvard, IL 60033-2871
Grant Number
H80CS00748
Participating Start Date
4/6/2020
Last Recertification Date
2/24/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0796
Pharmacy Address
5307 RT. 251
PERU, IL 61354
Pharmacy Comments
Contract Details
Approval Date
4/13/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Eleace Erica Sawyers, Chief Executive Officer
(786) 299-1724
Contract Pharmacy Representative
Wal Mart
Julie Howard, 340b Pharmacy Manager
(479) 739-1973
Signed By Date
4/13/2024
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