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WAL-MART PHARMACY 10-2914
CH053086D Lifecare Family Health and Dental Center, Inc
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Covered Entity Details
Entity Name
Lifecare Family Health and Dental Center, Inc
Subdivision Name
Massillon Professional Building
Type
HRSA-Funded Health Center
340B ID
CH053086D
Entity Address
830 Amherst Rd NE
Massillon, OH 44646-8525
Grant Number
H80CS06654
Participating Start Date
10/1/2020
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2914
Pharmacy Address
1 MASSILLON MARKET PLACE DR.
MASSILLON, OH 44646
Pharmacy Comments
Contract Details
Approval Date
7/24/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Eric Niemeyer, CEO
(330) 454-2000 Ext: 150
Contract Pharmacy Representative
Walmart
Julie Howard, 340b Program Manager
(479) 739-1973 Ext: 4792771498
Signed By Date
7/24/2024
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