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WAL-MART PHARMACY 10-3336
CH0537520 COVENANT COMMUNITY CARE, INC.
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Covered Entity Details
Entity Name
COVENANT COMMUNITY CARE, INC.
Subdivision Name
Covenant Michigan Avenue Clinic
Type
HRSA-Funded Health Center
340B ID
CH0537520
Entity Address
5716 Michigan Ave
Detroit, MI 48210-3039
Grant Number
H80CS08738
Participating Start Date
10/1/2007
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-3336
Pharmacy Address
23800 ALLEN ROAD
WOODHAVEN, MI 48183
Pharmacy Comments
Contract Details
Approval Date
1/15/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/24/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Paul Propson, CEO
(313) 228-0216
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
1/15/2016
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