Contract Pharmacy Details

WAL-MART PHARMACY 10-1058
CHC24176-00 OLATHE COMMUNITY CLINIC, INC.

Covered Entity Details

Entity Name

OLATHE COMMUNITY CLINIC, INC.

Subdivision Name

Olathe Community Clinic, Inc.

Type

HRSA-Funded Health Center

340B ID

CHC24176-00

Entity Address

308 Main Street
Olathe, CO 81425

Grant Number

H80CS24176

Participating Start Date

4/1/2014

Last Recertification Date

2/14/2025

Pharmacy Details

Pharmacy Name

WAL-MART PHARMACY 10-1058

Pharmacy Address

16750 S. TOWNSEND
MONTROSE, CO 81401

Pharmacy Comments

Contract Details

Approval Date

4/16/2018

Contract Begin Date

7/1/2018

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Jeremy Carroll, CEO
(970) 263-1701

Contract Pharmacy Representative

Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498

Signed By Date

4/16/2018

340B Drug Pricing Program Database