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WALMART PHARMACY #10-4424
CHC26572-03 MyCare Heatlh Center
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Covered Entity Details
Entity Name
MyCare Heatlh Center
Subdivision Name
Sacred Heart
Type
HRSA-Funded Health Center
340B ID
CHC26572-03
Entity Address
28303 Dequindre Rd
Ste 100
Madison Heights, MI 48071-3040
Grant Number
H80CS26572
Participating Start Date
7/1/2014
Last Recertification Date
2/5/2020
Entity Termination Date
10/1/2020
Pharmacy Details
Pharmacy Name
WALMART PHARMACY #10-4424
Pharmacy Address
29176 VAN DYKE AVENUE
WARREN, MI 48093
Pharmacy Comments
Contract Details
Approval Date
4/11/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Karen Wood, Wood
(586) 619-9986 Ext: 13
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
4/11/2018
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