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WAL-MART PHARMACY 10-1641
CH042820B Metropolitan Community Health
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Covered Entity Details
Entity Name
Metropolitan Community Health
Subdivision Name
Agape Health Services- Plymouth
Type
HRSA-Funded Health Center
340B ID
CH042820B
Entity Address
115 Adams St
Plymouth, NC 27962-1307
Grant Number
H80CS00864
Participating Start Date
1/1/2023
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1641
Pharmacy Address
1529 WASHINGTON ST
WILLIAMSTON, NC 27892
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
Laurence J Doby, Executive Director
(252) 644-7003
Contract Pharmacy Representative
Metropolitan Community Health Services
Frank K Debrah, Chief Pharmacy Director
(252) 789-0401
Signed By Date
4/15/2024
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