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WAL-MART PHARMACY 10-3245
CHC08784-00 LAKES COMMUNITY HEALTH CENTER, INC., THE
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Covered Entity Details
Entity Name
LAKES COMMUNITY HEALTH CENTER, INC., THE
Subdivision Name
NorthLakes - Iron River
Type
HRSA-Funded Health Center
340B ID
CHC08784-00
Entity Address
7665 Us Highway 2
Iron River, WI 54847-4690
Grant Number
H80CS08784
Participating Start Date
7/1/2010
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-3245
Pharmacy Address
15594 STATE HIGHWAY 77
HAYWARD, WI 54843
Pharmacy Comments
Contract Details
Approval Date
1/9/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jason Akl, COO
(715) 372-5001 Ext: 1211
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
1/9/2014
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