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WALMART PHARMACY 10-5169
STD712631 Community Medical Clinic
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Covered Entity Details
Entity Name
Community Medical Clinic
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD712631
Entity Address
712 Settoon Street
Oak Grove, LA 71263
Grant Number
NH25PS005176
Participating Start Date
10/1/2024
Last Recertification Date
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-5169
Pharmacy Address
2252 NORTH 8TH STREET
SUITE A
ROGERS, AR 72756
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
Amanda D Grey, COO
(318) 428-3237
Contract Pharmacy Representative
Walmart
Nick Tallman, Sr. Director, Merchandise Operations – Pharmacy
(479) 371-0417
Signed By Date
10/15/2024
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