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WAL-MART PHARMACY 10-1414
CH06024H FIRST CHOICE COMMUNITY HEALTHCARE
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Covered Entity Details
Entity Name
FIRST CHOICE COMMUNITY HEALTHCARE
Subdivision Name
BELEN CENTER
Type
HRSA-Funded Health Center
340B ID
CH06024H
Entity Address
120 S 9th St
Belen, NM 87002-3102
Grant Number
H80CS00202
Participating Start Date
10/1/1999
Last Recertification Date
2/26/2024
Entity Termination Date
4/1/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1414
Pharmacy Address
1 I-25 BYPASS
BELEN, NM 87002
Pharmacy Comments
Contract Details
Approval Date
7/17/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
ROBERT DEFELICE, CEO
(505) 873-7401
Contract Pharmacy Representative
CH060240
ROBERT DEFELICE, CEO
(505) 873-7401
Signed By Date
7/17/2018
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