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WAL-MART PHARMACY 10-5129
CHC10591-00 COMMUNITY CLINIC, INC.
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Covered Entity Details
Entity Name
COMMUNITY CLINIC, INC.
Subdivision Name
CCI-Takoma Park
Type
HRSA-Funded Health Center
340B ID
CHC10591-00
Entity Address
7676 NEW HAMPSHIRE AVENUE
Suite 200
TAKOMA PARK, MD 20912
Grant Number
H80CS10591
Participating Start Date
4/1/2005
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5129
Pharmacy Address
6210 ANNAPOLIS RD
LANDOVER HILLS, MD 20784
Pharmacy Comments
Contract Details
Approval Date
1/12/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/1/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Marcia LoBrano, Chief Medical Officer
(240) 499-2615
Contract Pharmacy Representative
Wal-Mart
Marcus Osbourne, VP of Health and Wellness Transformation
(479) 204-9374
Signed By Date
1/12/2017
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