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WAL-MART CENTRAL FILL 10-2670
CH097880 PETALUMA HEALTH CENTER, INC
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Covered Entity Details
Entity Name
PETALUMA HEALTH CENTER, INC
Subdivision Name
Petaluma Health Center
Type
HRSA-Funded Health Center
340B ID
CH097880
Entity Address
1179 N. McDowell Blvd.
Petaluma, CA 94954-6559
Grant Number
H80CS00587
Participating Start Date
7/1/2000
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART CENTRAL FILL 10-2670
Pharmacy Address
608 SPRING HILL DR # 3 SUITE 300
SPRING, TX 77386
Pharmacy Comments
Contract Details
Approval Date
10/4/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brian Burns, CFO
(707) 559-7588
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/4/2018
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