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WAL-MART PHARMACY 10-2572
CH05290A COMMUNITY ACTION COMMITTEE OF PIKE COUNTY, THE
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Covered Entity Details
Entity Name
COMMUNITY ACTION COMMITTEE OF PIKE COUNTY, THE
Subdivision Name
FAMILY HEALTH -WAVERLY
Type
HRSA-Funded Health Center
340B ID
CH05290A
Entity Address
227 Valley View Dr
Waverly, OH 45690-9135
Grant Number
H80CS00399
Participating Start Date
10/1/1998
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2572
Pharmacy Address
990 WEST EMMITT AVENUE
WAVERLY, OH 45690
Pharmacy Comments
Contract Details
Approval Date
10/8/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Keith Pitts, President and Chief Executive Officer
(216) 770-3409 Ext: 7009
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
10/8/2024
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