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WAL-MART PHARMACY 10-0689
FQHCLA422E FAITH HEALTHCARE INC
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Covered Entity Details
Entity Name
FAITH HEALTHCARE INC
Subdivision Name
Mount Vernon Community Care
Type
Health Center Program Look-Alike
340B ID
FQHCLA422E
Entity Address
525 Richmond St
Mount Vernon, KY 40456-2718
Grant Number
LALCS40209
Participating Start Date
4/1/2024
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0689
Pharmacy Address
177 WASHINGTON DR
SOMERSET, KY 42501
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
Morgan Dishman, Chief Pharmacy Officer/340B Program Director
(270) 585-9726
Contract Pharmacy Representative
Walmart
Van Donn, Director of Contracting 340b
(303) 261-5549
Signed By Date
4/15/2024
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