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Walmart Pharmacy 10-7611
CHC24163-13 EAST HILL FAMILY MEDICAL INC.
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Covered Entity Details
Entity Name
EAST HILL FAMILY MEDICAL INC.
Subdivision Name
Herman Avenue Elementary School
Type
HRSA-Funded Health Center
340B ID
CHC24163-13
Entity Address
2 N Herman Ave
Auburn, NY 13021-2945
Grant Number
H80CS24163
Participating Start Date
7/1/2024
Last Recertification Date
3/6/2025
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
7/14/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
April Miles, President & CEO
(315) 612-3465 Ext: 3465
Contract Pharmacy Representative
Walmart
Van Donn, Director of Contracting 340b
(303) 261-5549
Signed By Date
7/14/2024
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