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WAL-MART PHARMACY 10-0233
CH050040 SHAWNEE HEALTH SERVICE AND DEVELOPMENT CORPORATION
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Covered Entity Details
Entity Name
SHAWNEE HEALTH SERVICE AND DEVELOPMENT CORPORATION
Subdivision Name
SHAWNEE HEALTH SERVICE AND DEVELOPMENT C
Type
HRSA-Funded Health Center
340B ID
CH050040
Entity Address
109 California St
Carterville, IL 62918-1923
Grant Number
H80CS00667
Participating Start Date
7/1/1998
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0233
Pharmacy Address
300 LEIGH AVENUE
ANNA, IL 62906
Pharmacy Comments
Contract Details
Approval Date
7/2/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Patsy R. Jensen, CEO
(618) 985-8221
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
7/2/2015
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