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WALMART PHARMACY #10-5807
CHC28366-00 HARBOR COMMUNITY CLINIC
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Covered Entity Details
Entity Name
HARBOR COMMUNITY CLINIC
Subdivision Name
6th Street Health Center
Type
HRSA-Funded Health Center
340B ID
CHC28366-00
Entity Address
593 West 6th Street
San Pedro, CA 90731
Grant Number
H80CS28366
Participating Start Date
1/1/2016
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
WALMART PHARMACY #10-5807
Pharmacy Address
WALMART STORES INC
2100 NORTH LONG BEACH BOULEVARD
COMPTON, CA 90221-7271
Pharmacy Comments
Contract Details
Approval Date
1/8/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/28/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Nathalia Jimenez, COO
(310) 547-0202 Ext: 134
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/8/2019
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