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WAL-MART PHARMACY 10-5982
FQHCLA247 HEALTH AND LIFE ORGANIZATION INC.
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Covered Entity Details
Entity Name
HEALTH AND LIFE ORGANIZATION INC.
Subdivision Name
SACRAMENTO COMMUNITY CLINIC - SOUTHGATE
Type
Health Center Program Look-Alike
340B ID
FQHCLA247
Entity Address
7275 E. SOUTHGATE DRIVE
SUITE 204
SACRAMENTO, CA 95823
Grant Number
LALCS00018
Participating Start Date
4/1/2009
Last Recertification Date
1/31/2023
Entity Termination Date
10/1/2023
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5982
Pharmacy Address
2700 MARCONI AVE.
SACRAMENTO, CA 95821
Pharmacy Comments
Contract Details
Approval Date
10/15/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
JERRY T. BLIATOUT, CEO
(916) 428-3788 Ext: 4236
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
10/15/2018
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