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WAL-MART PHARMACY 10-5391
CH041700 COLLIER HEALTH SERVICES, INC.
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Covered Entity Details
Entity Name
COLLIER HEALTH SERVICES, INC.
Subdivision Name
COLLIER HEALTH SERVICES, INC.
Type
HRSA-Funded Health Center
340B ID
CH041700
Entity Address
1454 Madison Ave W
Immokalee, FL 34142-2200
Grant Number
H80CS00735
Participating Start Date
12/1/1992
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5391
Pharmacy Address
5420 JULIET BOULEVARD
NAPLES, FL 34109
Pharmacy Comments
Contract Details
Approval Date
1/15/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mike Ellis, President/CEO
(239) 658-3158
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
1/15/2016
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