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WAL-MART PHARMACY 10-5220
CH0412810 TAMPA FAMILY HEALTH CENTERS, INC.
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Covered Entity Details
Entity Name
TAMPA FAMILY HEALTH CENTERS, INC.
Subdivision Name
TFHC #16 New Nebraska
Type
HRSA-Funded Health Center
340B ID
CH0412810
Entity Address
12410 N Nebraska Ave
Tampa, FL 33612
Grant Number
H80CS00407
Participating Start Date
7/1/1995
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5220
Pharmacy Address
8220 NORTH DALE MABRY HWY
TAMPA, FL 33614
Pharmacy Comments
Contract Details
Approval Date
4/9/2013
Contract Begin Date
7/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/15/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Edward Kucher, CFO
(813) 866-0930 Ext: 1311
Contract Pharmacy Representative
Marcus Osborne, Vice President
(479) 204-9374
Signed By Date
4/9/2013
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