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WAL-MART PHARMACY 10-0731
CH042850 RURAL HEALTH MEDICAL PROGRAM, INC.
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Covered Entity Details
Entity Name
RURAL HEALTH MEDICAL PROGRAM, INC.
Subdivision Name
Rural Health Medical Program, Inc.-Selma Health Center & Administrative Office
Type
HRSA-Funded Health Center
340B ID
CH042850
Entity Address
101 PARK PLACE
SELMA, AL 36701
Grant Number
H80CS00794
Participating Start Date
1/1/2003
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0731
Pharmacy Address
969 US HWY 80 WEST
DEMOPOLIS, AL 36732
Pharmacy Comments
Contract Details
Approval Date
1/4/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
KESHEE Danee DOZIER-SMITH, CEO
(334) 874-7428 Ext: 121
Contract Pharmacy Representative
Nuvem
Diego Serna, Account Manager
(888) 356-6225
Signed By Date
1/4/2025
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