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WAL-MART PHARMACY 10-5315
FQHCLA351D GREENE COUNTY HEALTH, INC.
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Covered Entity Details
Entity Name
GREENE COUNTY HEALTH, INC.
Subdivision Name
Greene County Health - Lonetree
Type
Health Center Program Look-Alike
340B ID
FQHCLA351D
Entity Address
1216 N. 1000 W.
Linton, IN 47441
Grant Number
LALCS31107
Participating Start Date
10/1/2017
Last Recertification Date
2/12/2018
Entity Termination Date
10/1/2018
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5315
Pharmacy Address
2354 COMMERCE PARK DR.
ORLANDO, FL 32819
Pharmacy Comments
Contract Details
Approval Date
10/13/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/13/2017
Agreement registered in error
Contacts
Covered Entity Signing Official
Elizabeth Burrows, Interim CEO
(812) 699-4153
Contract Pharmacy Representative
Wal-mart
Laura Levine, Manager Contracting
(479) 204-8550
Signed By Date
10/13/2017
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