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Walmart Pharmacy 10-7611
STD35983 Weiss Family Care
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Covered Entity Details
Entity Name
Weiss Family Care
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD35983
Entity Address
280 Industrial Blvd
Leesburg, AL 35983
Grant Number
6NH25PS005129-05-08
Participating Start Date
4/1/2025
Last Recertification Date
5/5/2025
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
4/2/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kristie Lauren Burt, Owner/CRNP
(256) 996-3852 Ext: 7066761241
Contract Pharmacy Representative
Walmart
Nick Tallman, Senior Director
(479) 371-0417
Signed By Date
4/2/2025
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