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WALMART PHARMACY 10-5169
CH05662J ALIVIO MEDICAL CENTER, INC
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Covered Entity Details
Entity Name
ALIVIO MEDICAL CENTER, INC
Subdivision Name
Benito Juarez Community Academy
Type
HRSA-Funded Health Center
340B ID
CH05662J
Entity Address
1450 W Cermak Rd
Chicago, IL 60608-4408
Grant Number
H80CS00116
Participating Start Date
7/1/2015
Last Recertification Date
2/26/2025
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
4/17/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ESTHER CORPUZ, CHIEF EXECUTIVE OFFICER
(312) 829-6304
Contract Pharmacy Representative
Wal-Mart
Marcus Osbourne, Vice President
(800) 939-2022
Signed By Date
4/17/2024
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