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WAL-MART PHARMACY 10-1652
CHC26516-05 FREE CLINIC OF NEW RIVER VALLEY INC
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Covered Entity Details
Entity Name
FREE CLINIC OF NEW RIVER VALLEY INC
Subdivision Name
Pulaski County High School Service Site
Type
HRSA-Funded Health Center
340B ID
CHC26516-05
Entity Address
5414 Cougar Trail Rd BLDG 2
Dublin, VA 24084-3841
Grant Number
H80CS26516
Participating Start Date
7/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1652
Pharmacy Address
5225 ALEXANDER ROAD
DUBLIN, VA 24084
Pharmacy Comments
Contract Details
Approval Date
4/29/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Albert Brogan, CFO
(540) 525-0623
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/10/2025
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