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WAL-MART PHARMACY 10-1369
CH09289P NORTH COUNTRY HEALTHCARE, INC.
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Covered Entity Details
Entity Name
NORTH COUNTRY HEALTHCARE, INC.
Subdivision Name
NORTH COUNTRY HEALTHCARE- PAYSON
Type
HRSA-Funded Health Center
340B ID
CH09289P
Entity Address
126 E Main St, Ste B
PAYSON, AZ 85541
Grant Number
H80CS00651
Participating Start Date
10/1/2014
Last Recertification Date
2/25/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1369
Pharmacy Address
300 NORTH BEELINE HWY.
PAYSON, AZ 85541
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
ANNE NEWLAND, CEO
(928) 522-9564
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/15/2024
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