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WAL-MART PHARMACY 10-5997
CH030820 MONONGAHELA VALLEY ASN HLTH CTRS
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Covered Entity Details
Entity Name
MONONGAHELA VALLEY ASN HLTH CTRS
Subdivision Name
MVA Health Center - Fairmont
Type
HRSA-Funded Health Center
340B ID
CH030820
Entity Address
1322 LOCUST AVENUE
FAIRMONT, WV 26554
Grant Number
H80CS00383
Participating Start Date
10/1/1995
Last Recertification Date
2/19/2025
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
7/26/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
NANCY L. VANDERGRIFT, CEO
(304) 367-8740
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
7/26/2017
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