Contract Pharmacy Details

WAL-MART PHARMACY 10-1482
CH0412810 TAMPA FAMILY HEALTH CENTERS, INC.

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 10-1482

Pharmacy Address

7011 WATERS AVE. WEST
TAMPA WEST, FL 33634

Pharmacy Comments

Contract Details

Approval Date

4/22/2015

Contract Begin Date

7/1/2015

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

6/21/2021
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Edward Kucher, CFO
(813) 866-0930 Ext: 1311

Contract Pharmacy Representative

Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374

Signed By Date

4/22/2015

340B Drug Pricing Program Database