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WAL-MART PHARMACY 10-2867
CH05183M INGHAM, COUNTY OF
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Covered Entity Details
Entity Name
INGHAM, COUNTY OF
Subdivision Name
Birch Community Health Center
Type
HRSA-Funded Health Center
340B ID
CH05183M
Entity Address
812 E Jolly Rd
Ste 112
Lansing, MI 48910-6818
Grant Number
H80CS00030
Participating Start Date
4/1/2017
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2867
Pharmacy Address
3225 TOWNE CENTRE BLVD
LANSING (N), MI 48912
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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