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Walmart Pharmacy 10-7611
CH048800 JEFFERSON COMPREHENSIVE HEALTH CENTER INC
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Covered Entity Details
Entity Name
JEFFERSON COMPREHENSIVE HEALTH CENTER INC
Subdivision Name
JEFFERSON COMPREHENSIVE HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH048800
Entity Address
405 Main Street
Fayette, MS 39069-0098
Grant Number
H80CS00582
Participating Start Date
12/1/1992
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
10/10/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Katrina Collins, Chief Executive Officer
(601) 786-3475
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/10/2024
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