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WAL-MART PHARMACY 10-5997
CH010150 COMMUNITY HEALTH CENTERS OF BURLINGTON, INC.
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Covered Entity Details
Entity Name
COMMUNITY HEALTH CENTERS OF BURLINGTON, INC.
Subdivision Name
Riverside Health Center
Type
HRSA-Funded Health Center
340B ID
CH010150
Entity Address
617 Riverside Ave
Burlington, VT 05401-1601
Grant Number
H80CS00311
Participating Start Date
7/1/1995
Last Recertification Date
2/10/2025
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
7/14/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Dave Simmons, CFO
(802) 264-8197
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
7/14/2017
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