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WALMART PHARMACY 10-5828
CH080170A PUEBLO COMMUNITY HEALTH CENTER
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Covered Entity Details
Entity Name
PUEBLO COMMUNITY HEALTH CENTER
Subdivision Name
Colorado Avenue Clinic
Type
HRSA-Funded Health Center
340B ID
CH080170A
Entity Address
300 Colorado Ave
Pueblo, CO 81004-2006
Grant Number
H80CS00692
Participating Start Date
1/1/2000
Last Recertification Date
3/2/2025
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-5828
Pharmacy Address
2730 S. PRAIRIE AVE
PUEBLO, CO 81005
Pharmacy Comments
Contract Details
Approval Date
1/7/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Donald Moore, CEO
(719) 543-8718 Ext: 139
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/7/2020
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