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WAL-MART PHARMACY 10-5690
CH099010 BORREGO COMMUNITY HEALTH FOUNDATION
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Covered Entity Details
Entity Name
BORREGO COMMUNITY HEALTH FOUNDATION
Subdivision Name
BORREGO COMMUNITY HEALTH FOUNDATION
Type
HRSA-Funded Health Center
340B ID
CH099010
Entity Address
4343 YAQUI PASS ROAD
BORREGO SPRINGS, CA 92004-2369
Grant Number
H80CS00287
Participating Start Date
1/1/2003
Last Recertification Date
2/13/2023
Entity Termination Date
4/1/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5690
Pharmacy Address
2045 E HIGHLAND AVE.
SAN BERNARDINO, CA 92404
Pharmacy Comments
Contract Details
Approval Date
7/13/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/13/2016
Pharmacy closed
Contacts
Covered Entity Signing Official
BRUCE HEBETS, CEO
(760) 767-6433
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
7/13/2016
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