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WAL-MART PHARMACY 10-2644
CH05036C Great Lakes Bay Health Centers
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Covered Entity Details
Entity Name
Great Lakes Bay Health Centers
Subdivision Name
Great Lakes Bay Health Centers Janes Street
Type
HRSA-Funded Health Center
340B ID
CH05036C
Entity Address
1522 Janes St
Saginaw, MI 48601
Grant Number
H80CS00689
Participating Start Date
4/1/1999
Last Recertification Date
2/27/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2644
Pharmacy Address
5825 BROCKWAY ROAD
SAGINAW, MI 48638
Pharmacy Comments
Contract Details
Approval Date
10/16/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Brenda Marie Coughlin, President/CEO
(989) 759-6467
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
10/16/2017
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