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WAL-MART PHARMACY 10-2482
STD85028 RSG Healthcare
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Covered Entity Details
Entity Name
RSG Healthcare
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD85028
Entity Address
11209 N Tatum BLVD
STE 185
Phoenix, AZ 85028
Grant Number
NU62PS924818
Participating Start Date
7/1/2024
Last Recertification Date
5/13/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2482
Pharmacy Address
857 N DOBSON
MESA, AZ 85201
Pharmacy Comments
Contract Details
Approval Date
7/4/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/26/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Randy S Gelow, Owner/Medical Doctor
(602) 669-2585
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
7/4/2024
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