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WAL-MART PHARMACY 10-5997
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 10-5997
Pharmacy Address
9600 PARKSOUTH CT. SUITE 100
ORLANDO, FL 32837
Pharmacy Comments
Contract Details
Approval Date
1/23/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Wilson Forney, Chief Executive Officer
(419) 502-2818
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
1/23/2017
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