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WAL-MART PHARMACY 10-2869
CH05183N INGHAM, COUNTY OF
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Covered Entity Details
Entity Name
INGHAM, COUNTY OF
Subdivision Name
New Hope Community Health Center
Type
HRSA-Funded Health Center
340B ID
CH05183N
Entity Address
430 N. Larch St.
Suite 1
Lansing, MI 48912-1266
Grant Number
H80CS00030
Participating Start Date
1/1/2018
Last Recertification Date
1/29/2024
Entity Termination Date
1/1/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2869
Pharmacy Address
409 N. MARKET PLACE BLVD
LANSING (W), MI 48917
Pharmacy Comments
Contract Details
Approval Date
7/10/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2025
Covered Entity Terminated
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
7/10/2024
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