Contract Pharmacy Details

WAL-MART PHARMACY 10-1530
CH040780 DELTA HEALTH CENTER, INC.

Covered Entity Details

Entity Name

DELTA HEALTH CENTER, INC.

Subdivision Name

DELTA HEALTH CENTER, INC.

Type

HRSA-Funded Health Center

340B ID

CH040780

Entity Address

702 MARTIN L. KING ROAD
MOUND BAYOU, MS 38762-0900

Grant Number

H80CS00085

Participating Start Date

12/1/1992

Last Recertification Date

2/13/2025

Pharmacy Details

Pharmacy Name

WAL-MART PHARMACY 10-1530

Pharmacy Address

710 N DAVIS AVENUE
CLEVELAND, MS 38732

Pharmacy Comments

Contract Details

Approval Date

10/16/2015

Contract Begin Date

1/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/5/2022
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

John A. Fairman, CEO
(662) 741-8880

Contract Pharmacy Representative

WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498

Signed By Date

10/16/2015

340B Drug Pricing Program Database