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WAL-MART PHARMACY 10-1451
CHC08777-00 COUNTY OF CASS
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Covered Entity Details
Entity Name
COUNTY OF CASS
Subdivision Name
CASS COUNTY HEALTH DEPARTMENT
Type
HRSA-Funded Health Center
340B ID
CHC08777-00
Entity Address
331 S Main St
Virginia, IL 62691-1519
Grant Number
H80CS08777
Participating Start Date
1/1/2010
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1451
Pharmacy Address
100 LINCOLN AVE
BEARDSTOWN, IL 62618
Pharmacy Comments
Contract Details
Approval Date
4/20/2012
Contract Begin Date
4/26/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
TERESA SMITH, ADMINISTRATOR
(217) 452-3057
Contract Pharmacy Representative
Wal--Mart
Marcus Osborne, Sales & Contracting
(479) 204-8452
Signed By Date
4/20/2012
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