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WAL-MART PHARMACY 10-2950
CH0925360 JWCH INSTITUTE, INC.
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Covered Entity Details
Entity Name
JWCH INSTITUTE, INC.
Subdivision Name
JWCH Institute Corporate Headquarters
Type
HRSA-Funded Health Center
340B ID
CH0925360
Entity Address
5650 JILLSON ST
COMMERCE, CA 90040-1482
Grant Number
H80CS06673
Participating Start Date
9/16/2005
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2950
Pharmacy Address
37140 47TH STREET EAST
PALMDALE, CA 93552
Pharmacy Comments
Contract Details
Approval Date
7/15/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ALVARO BALLESTEROS, EXECUTIVE DIRECTOR
(323) 201-4516 Ext: 3009
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
7/15/2019
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