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WAL-MART PHARMACY 10-1692
CHC28992-03 Sac Health System
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Covered Entity Details
Entity Name
Sac Health System
Subdivision Name
SACHS-Frazee Clinic
Type
HRSA-Funded Health Center
340B ID
CHC28992-03
Entity Address
488 S K St
San Bernardino, CA 92410-2641
Grant Number
H80CS28992
Participating Start Date
7/1/2018
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1692
Pharmacy Address
1120 SOUTH MT VERNON AVE
COLTON, CA 92324
Pharmacy Comments
Contract Details
Approval Date
4/17/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/28/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
bonnie inquinn chi-lum, CMO
(951) 235-0642
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
4/17/2019
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