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WAL-MART PHARMACY 10-2196
FQHC638398 JAMESTOWN S'KLALLAM TRIBE
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Covered Entity Details
Entity Name
JAMESTOWN S'KLALLAM TRIBE
Subdivision Name
Jamestown Family Health Clinic
Type
Tribal Contract/Compact with IHS (P.L. 93-638)
340B ID
FQHC638398
Entity Address
808 N. 5th Avenue
SEQUIM, WA 98382
Grant Number
Participating Start Date
1/1/2001
Last Recertification Date
3/5/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2196
Pharmacy Address
3411 E KOLONELS WAY
PORT ANGELES, WA 98362-9089
Pharmacy Comments
Contract Details
Approval Date
10/8/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brent D. Simcosky, Director of Health Services
(360) 582-4870
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
10/8/2018
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