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WAL-MART PHARMACY 10-4403
CH02179R HUDSON HEADWATERS HEALTH NETWORK
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Covered Entity Details
Entity Name
HUDSON HEADWATERS HEALTH NETWORK
Subdivision Name
Champlain Family Health
Type
HRSA-Funded Health Center
340B ID
CH02179R
Entity Address
828 State Route 11
Champlain, NY 12919-4819
Grant Number
H80CS00159
Participating Start Date
10/1/2012
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-4403
Pharmacy Address
24 QUAKER RIDGE BLVD.
QUEENSBURY, NY 12804
Pharmacy Comments
Contract Details
Approval Date
1/3/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
James T Donnelly, EVP of 340B Pharmacy Services
(518) 824-2340
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
1/3/2014
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