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WAL-MART PHARMACY 10-1739
CH03170R Centerville Clinics, Incorporated
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Covered Entity Details
Entity Name
Centerville Clinics, Incorporated
Subdivision Name
Connellsville Medical and Dental Center
Type
HRSA-Funded Health Center
340B ID
CH03170R
Entity Address
601 S Arch St
Connellsville, PA 15425-4000
Grant Number
H80CS00705
Participating Start Date
1/1/2022
Last Recertification Date
2/20/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1739
Pharmacy Address
30 TRINITY POINT DRIVE
WASHINGTON, PA 15301
Pharmacy Comments
Contract Details
Approval Date
10/7/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Barry R Niccolai, Executive Director
(724) 632-6801 Ext: 1100
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
10/7/2024
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