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WAL-MART PHARMACY 10-1486
CH034180 SOUTHERN DOMINION HEALTH SYSTEMS, INC.
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Covered Entity Details
Entity Name
SOUTHERN DOMINION HEALTH SYSTEMS, INC.
Subdivision Name
ADMINISTRATIVE OFFICE
Type
HRSA-Funded Health Center
340B ID
CH034180
Entity Address
1508 K-V ROAD
VICTORIA, VA 23974
Grant Number
H80CS00173
Participating Start Date
12/1/1992
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1486
Pharmacy Address
1800 PERRY DR
FARMVILLE, VA 23901
Pharmacy Comments
Contract Details
Approval Date
10/15/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
April King, CEO
(434) 696-2165 Ext: 212
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/15/2024
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