Contract Pharmacy Details

WAL-MART PHARMACY 10-0547
CH041750 SUNCOAST COMMUNITY HEALTH CENTERS, INC.

Covered Entity Details

Entity Name

SUNCOAST COMMUNITY HEALTH CENTERS, INC.

Subdivision Name

SUNCOAST COMMUNITY HEALTH CENTERS, INC.

Type

HRSA-Funded Health Center

340B ID

CH041750

Entity Address

820 15th ST SE
Ruskin, FL 33570

Grant Number

H80CS00541

Participating Start Date

12/1/1992

Last Recertification Date

2/14/2025

Pharmacy Details

Pharmacy Name

WAL-MART PHARMACY 10-0547

Pharmacy Address

2602 JIM REDMAN PARKWAY
PLANT CITY, FL 33566

Pharmacy Comments

Contract Details

Approval Date

7/15/2016

Contract Begin Date

10/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/31/2019
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Bradley Herremans, CEO
(813) 653-6268

Contract Pharmacy Representative

Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374

Signed By Date

7/15/2016

340B Drug Pricing Program Database