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Walmart Pharmacy 10-7611
CH05183Q COUNTY OF INGHAM
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Covered Entity Details
Entity Name
COUNTY OF INGHAM
Subdivision Name
East Lansing Community Health Center
Type
HRSA-Funded Health Center
340B ID
CH05183Q
Entity Address
509 Burcham Dr
East Lansing, MI 48823-2750
Grant Number
H80CS00030
Participating Start Date
4/1/2024
Last Recertification Date
Entity Termination Date
1/1/2025
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
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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