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WAL-MART PHARMACY 10-2758
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 10-2758
Pharmacy Address
683 TENNY MOUNTAIN HIGHWAY
PLYMOUTH, NH 03264
Pharmacy Comments
Contract Details
Approval Date
10/17/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/11/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
EDWARD D. SHANSHALA II, CEO
(603) 444-8223
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
10/17/2016
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