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WAL-MART PHARMACY 10-0425
CHC24177-00 CAHABA MEDICAL CARE FOUNDATION
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Covered Entity Details
Entity Name
CAHABA MEDICAL CARE FOUNDATION
Subdivision Name
Cahaba Medical Care - Centreville Office
Type
HRSA-Funded Health Center
340B ID
CHC24177-00
Entity Address
405 Belcher St
Centreville, AL 35042-2946
Grant Number
H80CS24177
Participating Start Date
1/1/2014
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0425
Pharmacy Address
10675 HIGHWAY 5
BRENT, AL 35034
Pharmacy Comments
Contract Details
Approval Date
10/16/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
John Waits, CEO
(205) 277-2396
Contract Pharmacy Representative
Wal-Mart
Marcus Osbourne, VP of Health and Wellness Transformation
(479) 204-9374
Signed By Date
10/16/2016
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