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WAL-MART PHARMACY 10-2728
CH053150 COMMUNITY HEALTH IMPROVEMENT CENTER
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Covered Entity Details
Entity Name
COMMUNITY HEALTH IMPROVEMENT CENTER
Subdivision Name
COMMUNITY HEALTH IMPROVEMENT CENTER
Type
HRSA-Funded Health Center
340B ID
CH053150
Entity Address
320 East Central Avenue
Decatur, IL 62521-4665
Grant Number
H80CS00681
Participating Start Date
12/1/1992
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2728
Pharmacy Address
4625 EAST MARYLAND AVENUE
DECATUR (S), IL 62521
Pharmacy Comments
Contract Details
Approval Date
1/3/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lois Tanner, CFO
(217) 877-6127
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
1/3/2017
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