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Walmart Pharmacy 10-7611
CH044245T Pancare of Florida Inc
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Covered Entity Details
Entity Name
Pancare of Florida Inc
Subdivision Name
PanCare Youngstown
Type
HRSA-Funded Health Center
340B ID
CH044245T
Entity Address
12427 Highway 231
Youngstown, FL 32466
Grant Number
H80CS06452
Participating Start Date
10/1/2019
Last Recertification Date
2/25/2025
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
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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