Contract Pharmacy Details

WAL-MART PHARMACY 10-1756
CHC28985-00 CENTRAL NEIGHBORHOOD HEALTH FOUNDATION

Covered Entity Details

Entity Name

CENTRAL NEIGHBORHOOD HEALTH FOUNDATION

Subdivision Name

Central Neighborhood Health Foundation

Type

HRSA-Funded Health Center

340B ID

CHC28985-00

Entity Address

2614 S Grand Ave
Los Angeles, CA 90007-2607

Grant Number

H80CS28985

Participating Start Date

1/1/2016

Last Recertification Date

2/12/2025

Pharmacy Details

Pharmacy Name

WAL-MART PHARMACY 10-1756

Pharmacy Address

17251 FOOTHILL BLVD
FONTANA, CA 92335

Pharmacy Comments

Contract Details

Approval Date

7/18/2018

Contract Begin Date

10/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/1/2019
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Bassett Brown, Chief Executive Officer
(626) 252-5646

Contract Pharmacy Representative

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

Signed By Date

7/18/2018

340B Drug Pricing Program Database