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WALMART PHARMACY 10-5632
CH090390 CLINICA SIERRA VISTA
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Covered Entity Details
Entity Name
CLINICA SIERRA VISTA
Subdivision Name
CORPORATE HQ - CLINICA SIERRA VISTA
Type
HRSA-Funded Health Center
340B ID
CH090390
Entity Address
1430 Truxtun Ave STE 400
Bakersfield, CA 93301
Grant Number
H80CS00540
Participating Start Date
1/1/2004
Last Recertification Date
3/3/2025
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-5632
Pharmacy Address
1804 EAST ASHLAN AVE.
FRESNO, CA 93726
Pharmacy Comments
Contract Details
Approval Date
1/10/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brian Harris, CEO
(661) 635-3050 Ext: 2152
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
1/10/2019
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