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WAL-MART PHARMACY 10-1915
CHC26610-00 HI-DESERT MEMORIAL HEALTH CARE DISTRICT
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Covered Entity Details
Entity Name
HI-DESERT MEMORIAL HEALTH CARE DISTRICT
Subdivision Name
Morongo Basin Community Health Center-SR
Type
HRSA-Funded Health Center
340B ID
CHC26610-00
Entity Address
6380 Split Rock Ave
Twentynine Palms, CA 92277
Grant Number
H80CS26610
Participating Start Date
7/1/2015
Last Recertification Date
2/24/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1915
Pharmacy Address
58501 29 PALMS HWY
YUCCA VALLEY, CA 92284
Pharmacy Comments
Contract Details
Approval Date
7/10/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jacqueline Combs, EXECUTIVE DIRECTOR
(760) 820-9229
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
7/10/2018
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