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WAL-MART PHARMACY 10-1608
FQHC638005A GREENVILLE RANCHERIA TRIBAL HEALTH
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Covered Entity Details
Entity Name
GREENVILLE RANCHERIA TRIBAL HEALTH
Subdivision Name
Type
Tribal Contract/Compact with IHS (P.L. 93-638)
340B ID
FQHC638005A
Entity Address
1425 MONTGOMERY ROAD
RED BLUFF, CA 96080
Grant Number
Participating Start Date
7/1/2016
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1608
Pharmacy Address
608 LUTHER
RED BLUFF, CA 96080
Pharmacy Comments
Contract Details
Approval Date
4/15/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lucretia Fletcher, Tribal Administrator
(530) 528-8600 Ext: 200
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
4/15/2019
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