340B Drug Pricing Program Database
WAL-MART PHARMACY 10-3464
FQHCLA397C Health Service Alliance - information as of 4/30/2025 11:12:33 PM
Covered Entity Details
Entity Name
Health Service Alliance
Subdivision Name
Rancho Cucamonga Community Health Center
Type
Health Center Program Look-Alike
340B ID
FQHCLA397C
Entity Address
10837 Laurel St, Ste 204
Rancho Cucamonga, CA 91730-7657
Grant Number
LALCS33333
Participating Start Date
10/1/2023
Last Recertification Date
3/6/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-3464
Pharmacy Address
3943 GRAND AVENUE
CHINO, CA 91710
Pharmacy Comments
Contract Details
Approval Date
4/15/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Christen Grelling, Chief Operations Officer
(909) 464-9675 Ext: 104
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/15/2025
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