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WAL-MART PHARMACY 10-2758
CHC26640-00 MID-STATE HEALTH CENTER
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Covered Entity Details
Entity Name
MID-STATE HEALTH CENTER
Subdivision Name
Mid-State Health Center Plymouth
Type
HRSA-Funded Health Center
340B ID
CHC26640-00
Entity Address
101 Boulder Point Dr STE 1
Plymouth, NH 03264-3170
Grant Number
H80CS26640
Participating Start Date
4/1/2014
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2758
Pharmacy Address
683 TENNY MOUNTAIN HIGHWAY
PLYMOUTH, NH 03264
Pharmacy Comments
Contract Details
Approval Date
1/15/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Sharon Beaty, CEO
(603) 536-4000 Ext: 1001
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
1/15/2014
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