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WALMART PHARMACY 10-5169
CH05006AA COMMUNITY HEALTH PARTNERSHIP OF ILLINOIS
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Covered Entity Details
Entity Name
COMMUNITY HEALTH PARTNERSHIP OF ILLINOIS
Subdivision Name
Mobile Medical and Dental Van 02
Type
HRSA-Funded Health Center
340B ID
CH05006AA
Entity Address
202 N Schuyler Ave
Kankakee, IL 60901-3865
Grant Number
H80CS00748
Participating Start Date
7/1/2024
Last Recertification Date
2/24/2025
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
5/20/2024
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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