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WAL-MART PHARMACY 10-5997
CH05039B NORTHWEST MICHIGAN HEALTH SERVICES, INC
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Covered Entity Details
Entity Name
NORTHWEST MICHIGAN HEALTH SERVICES, INC
Subdivision Name
Northwest Michigan Health Services, Inc.
Type
HRSA-Funded Health Center
340B ID
CH05039B
Entity Address
119 S State St
Shelby, MI 49455-1243
Grant Number
H80CS00669
Participating Start Date
4/1/2002
Last Recertification Date
2/28/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5997
Pharmacy Address
9600 PARKSOUTH CT. SUITE 100
ORLANDO, FL 32837
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
Heidi Britton, Chief Executive Officer
(231) 947-1112
Contract Pharmacy Representative
Walmart
Nick Tallman, Sr. Director, Merchandise Operations – Pharmacy
(479) 371-0417
Signed By Date
4/14/2025
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