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WAL-MART CENTRAL FILL 10-2670
CH092500 IMPERIAL BEACH COMMUNITY CLINIC
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Covered Entity Details
Entity Name
IMPERIAL BEACH COMMUNITY CLINIC
Subdivision Name
IMPERIAL BEACH HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH092500
Entity Address
949 Palm Ave
Imperial Beach, CA 91932-1503
Grant Number
H80CS06648
Participating Start Date
4/1/1996
Last Recertification Date
2/26/2025
Pharmacy Details
Pharmacy Name
WAL-MART CENTRAL FILL 10-2670
Pharmacy Address
608 SPRING HILL DR # 3 SUITE 300
SPRING, TX 77386
Pharmacy Comments
Contract Details
Approval Date
1/3/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
CONSTANCE KIRK, CEO
(619) 429-5387
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/3/2020
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