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WAL-MART PHARMACY 10-2672
CH080030 VALLEY-WIDE HEALTH SYSTEMS, INC.
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Covered Entity Details
Entity Name
VALLEY-WIDE HEALTH SYSTEMS, INC.
Subdivision Name
Alamosa Family Medical Center, Valley Wide Pharmacy, or Anti-Coagulation Clinic
Type
HRSA-Funded Health Center
340B ID
CH080030
Entity Address
1710 1st St
Alamosa, CO 81101
Grant Number
H80CS00134
Participating Start Date
12/1/1992
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2672
Pharmacy Address
1432 EAST OLIVE
LAMAR, CO 81052
Pharmacy Comments
Contract Details
Approval Date
7/30/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/14/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
JEANNE DARRICADES, PRESIDENT/CEO
(719) 589-5161
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
7/30/2018
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