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WAL-MART PHARMACY 10-5409
CHC26576-00 Dayton Health Center dba Five Rivers Health Centers
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Covered Entity Details
Entity Name
Dayton Health Center dba Five Rivers Health Centers
Subdivision Name
Five Rivers Health Centers Edgemont Campus
Type
HRSA-Funded Health Center
340B ID
CHC26576-00
Entity Address
721 Miami Chapel Road
Dayton, OH 45417
Grant Number
H80CS26576
Participating Start Date
7/1/2014
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5409
Pharmacy Address
7725 HOKE ROAD
ENGLEWOOD, OH 45315
Pharmacy Comments
Contract Details
Approval Date
1/15/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/14/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Diane M. Cummins, Chief Operating Officer
(937) 281-5942
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
1/15/2018
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