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WALMART PHARMACY 10-5169
CH05183H INGHAM, COUNTY OF
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Covered Entity Details
Entity Name
INGHAM, COUNTY OF
Subdivision Name
Mobile Dental Center
Type
HRSA-Funded Health Center
340B ID
CH05183H
Entity Address
2316 S Cedar St
Lansing, MI 48910-3152
Grant Number
H80CS00030
Participating Start Date
4/1/2017
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
7/3/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kris Drake, Executive Director/Deputy Health Officer
(517) 887-4361
Contract Pharmacy Representative
Walmart
Van Donn, Director of Contracting
(479) 277-3719
Signed By Date
7/3/2024
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