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WAL-MART PHARMACY 10-5498
CHC24165-09 North Country Family Health Center, Inc.
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Covered Entity Details
Entity Name
North Country Family Health Center, Inc.
Subdivision Name
JCC Health & Wellness Center
Type
HRSA-Funded Health Center
340B ID
CHC24165-09
Entity Address
1220 Coffeen St Bldg 17
Watertown, NY 13601-1822
Grant Number
H80CS24165
Participating Start Date
7/1/2020
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5498
Pharmacy Address
7155 STATE ROUTE #12 SOUTH
LOWVILLE, NY 13367
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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