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Walmart Pharmacy 10-7611
CHC26636-04 ROCKBRIDGE AREA FREE CLINIC
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Covered Entity Details
Entity Name
ROCKBRIDGE AREA FREE CLINIC
Subdivision Name
RAHC Mobile Dental Unit
Type
HRSA-Funded Health Center
340B ID
CHC26636-04
Entity Address
25 Northridge Ln
Lexington, VA 24450-3399
Grant Number
H80CS26636
Participating Start Date
10/1/2024
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
1/3/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Suzanne Sheridan, Chief Executive Officer
(540) 464-8700 Ext: 7111
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
1/3/2025
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