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WAL-MART PHARMACY 10-1375
CH044245F PANCARE OF FLORIDA INC
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Covered Entity Details
Entity Name
PANCARE OF FLORIDA INC
Subdivision Name
PanCare-Liberty
Type
HRSA-Funded Health Center
340B ID
CH044245F
Entity Address
11033 NW State Road 20
Bristol, FL 32321-6406
Grant Number
H80CS06452
Participating Start Date
7/1/2014
Last Recertification Date
2/25/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1375
Pharmacy Address
2255 HIGHWAY 71
MARIANNA, FL 32448
Pharmacy Comments
Contract Details
Approval Date
7/2/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Robert Thompson, CEO
(850) 747-5599
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
7/2/2024
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