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Walmart Pharmacy 10-7611
CH0526690 Partnership Community Health Center
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Covered Entity Details
Entity Name
Partnership Community Health Center
Subdivision Name
Medical and Behavioral Health
Type
HRSA-Funded Health Center
340B ID
CH0526690
Entity Address
5471 Waterford Lane
Appleton, WI 54913-1110
Grant Number
H80CS04197
Participating Start Date
9/9/2005
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
10/9/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kristene S Stacker, CEO
(920) 740-7280
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/9/2024
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