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WAL-MART PHARMACY 10-2159
CHC24140-04 Southern Tier Community Health Center Network
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Covered Entity Details
Entity Name
Southern Tier Community Health Center Network
Subdivision Name
Southern Tier Community Health Center Network, Bradford site
Type
HRSA-Funded Health Center
340B ID
CHC24140-04
Entity Address
159 Interstate Pkwy
Bradford, PA 16701-1013
Grant Number
H80CS24140
Participating Start Date
4/1/2020
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2159
Pharmacy Address
RTE 417
1869 PLAZA DR
OLEAN, NY 14760
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
Brett Lawton, CEO
(716) 701-6831
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
7/1/2024
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