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WAL-MART PHARMACY 10-5997
CHC00396-00 FISH RIVER RURAL HEALTH
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Covered Entity Details
Entity Name
FISH RIVER RURAL HEALTH
Subdivision Name
EAGLE LAKE HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CHC00396-00
Entity Address
10 CARTER STREET
EAGLE LAKE, ME 04739
Grant Number
H80CS00396
Participating Start Date
10/1/2010
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5997
Pharmacy Address
9600 PARKSOUTH CT. SUITE 100
ORLANDO, FL 32837
Pharmacy Comments
Contract Details
Approval Date
7/9/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Heather A Pelletier, Executive Director/CEO
(207) 444-5973 Ext: 218
Contract Pharmacy Representative
Walmart
Tisha Campbell, Director of Contracting
(949) 872-4138
Signed By Date
7/9/2024
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