Contract Pharmacy Details

WAL-MART PHARMACY 10-1326
CHC26562-00 HEARTLAND HEALTH CENTER, INC.

Covered Entity Details

Entity Name

HEARTLAND HEALTH CENTER, INC.

Subdivision Name

Heartland Health Center, Inc.

Type

HRSA-Funded Health Center

340B ID

CHC26562-00

Entity Address

3307 W CAPITAL AVE
GRAND ISLAND, NE 68803-1334

Grant Number

H80CS26562

Participating Start Date

10/1/2014

Last Recertification Date

2/1/2022

Entity Termination Date

7/1/2022

Pharmacy Details

Pharmacy Name

WAL-MART PHARMACY 10-1326

Pharmacy Address

2250 NO. DIERS AVE
GRAND ISLAND, NE 68803

Pharmacy Comments

Contract Details

Approval Date

2/16/2015

Contract Begin Date

4/1/2015

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2022
Covered Entity Terminated

Contacts

Covered Entity Signing Official

KARI L WILCOX, CFO
(308) 382-4297

Contract Pharmacy Representative

Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719

Signed By Date

2/16/2015

340B Drug Pricing Program Database