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WAL-MART PHARMACY 10-2196
CHC28357-00 NORTH OLYMPIC HEALTHCARE NETWORK PC
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Covered Entity Details
Entity Name
NORTH OLYMPIC HEALTHCARE NETWORK PC
Subdivision Name
North Olympic Healthcare Network PC
Type
HRSA-Funded Health Center
340B ID
CHC28357-00
Entity Address
240 W FRONT ST
PORT ANGELES, WA 98362-2609
Grant Number
H80CS28357
Participating Start Date
1/1/2016
Last Recertification Date
2/11/2025
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
1/8/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Beau Jacob Brown, Chief Financial Officer
(360) 452-7891 Ext: 2828
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/8/2019
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