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WALMART PHARMACY 10-5169
CHC24165-08 NORTH COUNTRY FAMILY HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
NORTH COUNTRY FAMILY HEALTH CENTER, INC.
Subdivision Name
North Country Family Health Center - LeRay Dental
Type
HRSA-Funded Health Center
340B ID
CHC24165-08
Entity Address
26908 Independence Way, Suite 202
Evans Mills, NY 13637-3300
Grant Number
H80CS24165
Participating Start Date
7/1/2017
Last Recertification Date
2/10/2025
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
1/14/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Joey Marie Horton, Chief Executive Officer
(315) 782-9450
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/14/2025
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