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WAL-MART PHARMACY 10-5997
CH092080 ALLIANCE MEDICAL CENTER, INC.
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Covered Entity Details
Entity Name
ALLIANCE MEDICAL CENTER, INC.
Subdivision Name
ALLIANCE MEDICAL CENTER
Type
HRSA-Funded Health Center
340B ID
CH092080
Entity Address
1381 UNIVERSITY AVENUE
HEALDSBURG, CA 95448-3314
Grant Number
H80CS00249
Participating Start Date
4/1/1996
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5997
Pharmacy Address
9600 PARKSOUTH CT. SUITE 100
ORLANDO, FL 32837
Pharmacy Comments
Contract Details
Approval Date
7/12/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Alex Armstrong, CEO
(707) 385-2306
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
7/12/2018
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