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WAL-MART PHARMACY 10-5997
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 10-5997
Pharmacy Address
9600 PARKSOUTH CT. SUITE 100
ORLANDO, FL 32837
Pharmacy Comments
Contract Details
Approval Date
7/5/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
EDWARD D. SHANSHALA II, CEO
(603) 444-8223
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
7/5/2017
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