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WAL-MART PHARMACY 10-3059
CH047980 ARENIA C. MALLORY COMM HLTH CTR
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Covered Entity Details
Entity Name
ARENIA C. MALLORY COMM HLTH CTR
Subdivision Name
DR ARENIA C. MALLORY CHC, INC.
Type
HRSA-Funded Health Center
340B ID
CH047980
Entity Address
17280 Highway 17
Lexington, MS 39095-6614
Grant Number
H80CS00580
Participating Start Date
10/1/2015
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-3059
Pharmacy Address
244 FEATHER LANE
CANTON, MS 39046
Pharmacy Comments
Contract Details
Approval Date
10/3/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Clyde Rozell Chapman, CEO
(662) 834-2566 Ext: 1013
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
10/3/2024
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