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WAL-MART CENTRAL FILL 10-2670
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 CENTRAL FILL 10-2670
Pharmacy Address
608 SPRING HILL DR # 3 SUITE 300
SPRING, TX 77386
Pharmacy Comments
Contract Details
Approval Date
8/7/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jason Akl, COO
(715) 372-5001 Ext: 1211
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
8/7/2014
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