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WAL-MART PHARMACY 10-5997
CHC24140-00 Southern Tier Community Health Center Network
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Covered Entity Details
Entity Name
Southern Tier Community Health Center Network
Subdivision Name
Southern Tier Community Health Center Network, Olean site
Type
HRSA-Funded Health Center
340B ID
CHC24140-00
Entity Address
135 N. Union St.
Olean, NY 14760-2736
Grant Number
H80CS24140
Participating Start Date
3/1/2013
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5997
Pharmacy Address
9600 PARKSOUTH CT. SUITE 100
ORLANDO, FL 32837
Pharmacy Comments
Contract Details
Approval Date
7/14/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Gail Speedy Mayeaux, Executive Director
(716) 375-7500 Ext: 6831
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
7/14/2017
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