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WAL-MART PHARMACY 10-1348
CH05039F NORTHWEST MICHIGAN HEALTH SERVICES, INC
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Covered Entity Details
Entity Name
NORTHWEST MICHIGAN HEALTH SERVICES, INC
Subdivision Name
Traverse City West Middle School CAHC
Type
HRSA-Funded Health Center
340B ID
CH05039F
Entity Address
3954 Silver Lake Rd
Traverse City, MI 49684-8946
Grant Number
H80CS00669
Participating Start Date
7/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1348
Pharmacy Address
5135 CAROLINA BEACH RD
WILMINGTON (S), NC 28412
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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