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WAL-MART PHARMACY 10-5997
FQHCLA344E Tri-County Family Medicine Program, Inc.
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Covered Entity Details
Entity Name
Tri-County Family Medicine Program, Inc.
Subdivision Name
TCFM Wayland
Type
Health Center Program Look-Alike
340B ID
FQHCLA344E
Entity Address
200 N Main St
Wayland, NY 14572-1034
Grant Number
LALCS00181
Participating Start Date
1/1/2017
Last Recertification Date
2/11/2025
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
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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