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WAL-MART PHARMACY 10-3588
CHC12871-01 GREATER PRINCE WILLIAM COMMUNITY HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
GREATER PRINCE WILLIAM COMMUNITY HEALTH CENTER, INC.
Subdivision Name
Evergreen Terrace
Type
HRSA-Funded Health Center
340B ID
CHC12871-01
Entity Address
9705 Liberia Ave
Manassas, VA 20110-1743
Grant Number
H80CS12871
Participating Start Date
7/1/2014
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-3588
Pharmacy Address
17041 RICHMOND HWY
DUMFRIES, VA 22026
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
Mark Meye, Chief Executive Director
(703) 680-6524
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
1/14/2025
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