340B Drug Pricing Program Database
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Walmart Pharmacy 10-7611
CH040780 DELTA HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
DELTA HEALTH CENTER, INC.
Subdivision Name
DELTA HEALTH CENTER, INC.
Type
HRSA-Funded Health Center
340B ID
CH040780
Entity Address
702 MARTIN L. KING ROAD
MOUND BAYOU, MS 38762-0900
Grant Number
H80CS00085
Participating Start Date
12/1/1992
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
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
John A. Fairman, CEO
(662) 741-8880
Contract Pharmacy Representative
Walmart
Julie Howard, 340b Program Manager
(479) 739-1973 Ext: 4792771498
Signed By Date
4/15/2024
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