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WAL-MART PHARMACY 10-1454
CHC26512-00 PREFERRED FAMILY HEALTHCARE, INCORPORATED
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Covered Entity Details
Entity Name
PREFERRED FAMILY HEALTHCARE, INCORPORATED
Subdivision Name
Preferred Family Healthcare
Type
HRSA-Funded Health Center
340B ID
CHC26512-00
Entity Address
4355 Paris Gravel Rd.
Hannibal, MO 63401-6017
Grant Number
H80CS26512
Participating Start Date
7/1/2014
Last Recertification Date
3/1/2016
Entity Termination Date
7/1/2016
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1454
Pharmacy Address
5211 BROADWAY STREET
QUINCY, IL 62301
Pharmacy Comments
Contract Details
Approval Date
4/4/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2016
Contacts
Covered Entity Signing Official
Michael Schwend, CEO
(660) 626-0684
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
4/4/2016
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