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WAL-MART PHARMACY 10-1978
FQHCLA280A Knox/Winamac Community Health Centers, Inc.
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Covered Entity Details
Entity Name
Knox/Winamac Community Health Centers, Inc.
Subdivision Name
Knox/Winamac Community Health Centers
Type
Health Center Program Look-Alike
340B ID
FQHCLA280A
Entity Address
1002 S. Edgewood Dr.
Knox, IN 46534-8226
Grant Number
LALCS00038
Participating Start Date
10/1/2015
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1978
Pharmacy Address
2505 NORTH OAK RD
PLYMOUTH, IN 46563
Pharmacy Comments
Contract Details
Approval Date
7/10/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/9/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kathy Robb, Executive Director
(574) 772-6030 Ext: 24
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
7/10/2017
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