Contract Pharmacy Details

WAL-MART PHARMACY 10-3276
CHC28985-09 CENTRAL NEIGHBORHOOD HEALTH FOUNDATION

Covered Entity Details

Entity Name

CENTRAL NEIGHBORHOOD HEALTH FOUNDATION

Subdivision Name

Central Neighborhood Health Foundation/ Highland Ave

Type

HRSA-Funded Health Center

340B ID

CHC28985-09

Entity Address

742 W Highland Ave
San Bernardino, CA 92405-3839

Grant Number

H80CS28985

Participating Start Date

7/1/2018

Last Recertification Date

Entity Termination Date

4/1/2019

Pharmacy Details

Pharmacy Name

WAL-MART PHARMACY 10-3276

Pharmacy Address

4001 HALLMARK PKWY
SAN BERNARDINO (N), CA 92407

Pharmacy Comments

Contract Details

Approval Date

7/12/2018

Contract Begin Date

10/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2019
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Kenneth Orduna, CEO
(323) 547-1402

Contract Pharmacy Representative

WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498

Signed By Date

7/12/2018

340B Drug Pricing Program Database