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WAL-MART PHARMACY 10-4221
CH101230 VIRGINIA GARCIA MEMORIAL HEALTH CENTER
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Covered Entity Details
Entity Name
VIRGINIA GARCIA MEMORIAL HEALTH CENTER
Subdivision Name
VIRGINIA GARCIA MEMORIAL HEALTH CENTER - Cornelius
Type
HRSA-Funded Health Center
340B ID
CH101230
Entity Address
1151 N Adair Street
Cornelius, OR 97113-9029
Grant Number
H80CS00817
Participating Start Date
4/1/1996
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-4221
Pharmacy Address
220 N ADAIR
CORNELIUS, OR 97113
Pharmacy Comments
Contract Details
Approval Date
1/14/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Annmarie Rainford Dennis, Corporate Compliance Officer
(503) 214-1652
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
1/14/2019
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