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WAL-MART PHARMACY 10-0348
CHC24198-36 MARILLAC COMMUNITY HEALTH CENTERS
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Covered Entity Details
Entity Name
MARILLAC COMMUNITY HEALTH CENTERS
Subdivision Name
MCHC-Gould
Type
HRSA-Funded Health Center
340B ID
CHC24198-36
Entity Address
407 S Gould Ave
Gould, AR 71643-5041
Grant Number
H80CS24198
Participating Start Date
7/1/2024
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0348
Pharmacy Address
427 HWY 425 NORTH
MONTICELLO, AR 71655
Pharmacy Comments
Contract Details
Approval Date
4/14/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael Griffin, President and CEO
(504) 212-9502
Contract Pharmacy Representative
Walmart
Van Donn, Director of Contracting 340b
(303) 261-5549
Signed By Date
4/14/2025
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