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WALMART PHARMACY 10-5169
FQHCLA459 ONE CROSS COMMUNITY INC
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Covered Entity Details
Entity Name
ONE CROSS COMMUNITY INC
Subdivision Name
One Cross Community, Inc.
Type
Health Center Program Look-Alike
340B ID
FQHCLA459
Entity Address
429 W Walnut St
Lebanon, KY 40033-1346
Grant Number
LALCS52973
Participating Start Date
4/1/2024
Last Recertification Date
2/11/2025
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
7/1/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kim Mckenna, CEO
(270) 403-1106
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
7/1/2024
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