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WALMART PHARMACY 10-5059
CH0421240 FAIRVIEW COMMUNITY HEALTH CENTER
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Covered Entity Details
Entity Name
FAIRVIEW COMMUNITY HEALTH CENTER
Subdivision Name
DBA FAIRVIEW COMMUNITY HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH0421240
Entity Address
225 NATCHEZ TRACE AVE
BOWLING GREEN, KY 42103-7995
Grant Number
H80CS00856
Participating Start Date
10/1/2001
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-5059
Pharmacy Address
3106 CANTON STREET
HOPKINSVILLE, KY 42240
Pharmacy Comments
Contract Details
Approval Date
1/14/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
John Lillybridge, Executive Director
(270) 783-3573 Ext: 1032
Contract Pharmacy Representative
Walmart
Nick Tallman, Sr. Director, Merchandise Operations – Pharmacy
(479) 371-0417
Signed By Date
1/14/2025
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