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WALMART PHARMACY 10-3585
FQHCLA344C Tri-County Family Medicine Program, Inc.
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Covered Entity Details
Entity Name
Tri-County Family Medicine Program, Inc.
Subdivision Name
TCFM Dansville
Type
Health Center Program Look-Alike
340B ID
FQHCLA344C
Entity Address
60 Red Jacket St Ste 1
Dansville, NY 14437-1758
Grant Number
LALCS00181
Participating Start Date
1/1/2017
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-3585
Pharmacy Address
2901 RILEY FUZZELL RD
SPRING, TX 77386
Pharmacy Comments
Contract Details
Approval Date
7/14/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/10/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Joyce Wheaton, CEO
(585) 335-3416
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
7/14/2017
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