Contract Pharmacy Details

WALMART PHARMACY #10-4424
CH0537520 COVENANT COMMUNITY CARE, INC.

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

WALMART PHARMACY #10-4424

Pharmacy Address

29176 VAN DYKE AVENUE
WARREN, MI 48093

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

340B Drug Pricing Program Database