Contract Pharmacy Details

WAL-MART PHARMACY 10-5997
CHC24137-00 Ozarks Resource Group

Covered Entity Details

Entity Name

Ozarks Resource Group

Subdivision Name

OCHC - Hermitage Medical Center

Type

HRSA-Funded Health Center

340B ID

CHC24137-00

Entity Address

18614 Jackson St.
Hermitage, MO 65668-0021

Grant Number

H80CS24137

Participating Start Date

7/1/2013

Last Recertification Date

2/12/2025

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

7/19/2017

Contract Begin Date

10/1/2017

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Scott Crouch, CEO
(417) 745-2121

Contract Pharmacy Representative

Walmart
Julie Howard, 340B Program Manager
(479) 277-1498

Signed By Date

7/19/2017

340B Drug Pricing Program Database