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WAL-MART PHARMACY 10-2253
CH091520 MOUNTAIN HEALTH & COMMUNITY SERVICES, INC.
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Covered Entity Details
Entity Name
MOUNTAIN HEALTH & COMMUNITY SERVICES, INC.
Subdivision Name
Mountain Empire Family Medicine
Type
HRSA-Funded Health Center
340B ID
CH091520
Entity Address
31115 HIGHWAY 94
Campo, CA 91906-3133
Grant Number
H80CS00284
Participating Start Date
10/1/2002
Last Recertification Date
2/7/2020
Entity Termination Date
7/1/2020
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2253
Pharmacy Address
13487 CAMINO CANADA
EL CAJON (EAST), CA 92021
Pharmacy Comments
Contract Details
Approval Date
9/21/2012
Contract Begin Date
9/21/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Judith Shaplin, CEO
(619) 445-6200
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
8/23/2012
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