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WAL-MART PHARMACY 10-3397
CH040330 Jessie Trice Community Health System, Inc,
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Covered Entity Details
Entity Name
Jessie Trice Community Health System, Inc,
Subdivision Name
JTCHS - Fatima Zafar MD Health & Wellness Center
Type
HRSA-Funded Health Center
340B ID
CH040330
Entity Address
5361 NW 22nd Ave
Miami, FL 33142-8035
Grant Number
H80CS00732
Participating Start Date
12/1/1992
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-3397
Pharmacy Address
17650 NW 2ND AVE.
MIAMI GARDENS, FL 33169
Pharmacy Comments
Contract Details
Approval Date
10/3/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Annie Neasman, CEO
(305) 805-1700 Ext: 23151
Contract Pharmacy Representative
Wal-Mart
Marcus Osbourne, Vice President
(800) 939-2022
Signed By Date
10/3/2016
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