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WAL-MART PHARMACY 10-0454
CH052130 CHRISTOPHER RURAL HEALTH PLANNING CORP.
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Covered Entity Details
Entity Name
CHRISTOPHER RURAL HEALTH PLANNING CORP.
Subdivision Name
REA CLINIC
Type
HRSA-Funded Health Center
340B ID
CH052130
Entity Address
4241 HWY 14 WEST
CHRISTOPHER, IL 62822
Grant Number
H80CS00726
Participating Start Date
10/1/1998
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0454
Pharmacy Address
150 COMMERCE DR.
FAIRFIELD, IL 62837
Pharmacy Comments
Contract Details
Approval Date
10/13/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
KIMBERLY MITROKA, CEO
(618) 724-2436 Ext: 242
Contract Pharmacy Representative
Marcus Osborne, Vice President
(479) 273-4000
Signed By Date
10/13/2014
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