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WAL-MART PHARMACY 10-2681
CH010980 AMMONOOSUC COMMUNITY HEALTH SERVICES INC
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Covered Entity Details
Entity Name
AMMONOOSUC COMMUNITY HEALTH SERVICES INC
Subdivision Name
ACHS - Littleton
Type
HRSA-Funded Health Center
340B ID
CH010980
Entity Address
25 Mount Eustis Rd
Littleton, NH 03561-3712
Grant Number
H80CS00554
Participating Start Date
4/1/1996
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2681
Pharmacy Address
615 MEADOW STREET
LITTLETON, NH 03561
Pharmacy Comments
Contract Details
Approval Date
7/1/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
EDWARD D. SHANSHALA II, CEO
(603) 444-8223
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
7/1/2014
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