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WAL-MART PHARMACY 10-1445
CHC28351-00 FAMILY HEALTH SERVICES OF ERIE COUNTY
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Covered Entity Details
Entity Name
FAMILY HEALTH SERVICES OF ERIE COUNTY
Subdivision Name
Family Health Services of Erie County, Inc.
Type
HRSA-Funded Health Center
340B ID
CHC28351-00
Entity Address
1912 Hayes Ave
Sandusky, OH 44870
Grant Number
H80CS28351
Participating Start Date
10/1/2015
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1445
Pharmacy Address
2826 E. HARBOR ROAD
PORT CLINTON, OH 43452
Pharmacy Comments
Contract Details
Approval Date
7/14/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
David Walls, Pharmacy Manager
(419) 732-3369
Signed By Date
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