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WAL-MART STORES EAST LP
CHC08746-00 United Cerebral Palsy Association of the North Country, Inc.
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Covered Entity Details
Entity Name
United Cerebral Palsy Association of the North Country, Inc.
Subdivision Name
Type
HRSA-Funded Health Center
340B ID
CHC08746-00
Entity Address
4 COMMERCE LANE
CANTON, NY 13617-3739
Grant Number
H80CS08746
Participating Start Date
7/1/2009
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WAL-MART STORES EAST LP
Pharmacy Address
DBA WALMART PHARMAYCY #10-3334
3222 STATE ROUTE 11
MALONE, NY 12953
Pharmacy Comments
Contract Details
Approval Date
1/8/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Charles Sharlow, Chief Financial Officer
(315) 386-1156 Ext: 2010
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
1/8/2014
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