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WAL-MART PHARMACY 10-2886
CHC12858-04 FAMILY HEALTH CARE CENTERS OF GREATER LOS ANGELES, INC.
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Covered Entity Details
Entity Name
FAMILY HEALTH CARE CENTERS OF GREATER LOS ANGELES, INC.
Subdivision Name
Maywood Family Medical Center
Type
HRSA-Funded Health Center
340B ID
CHC12858-04
Entity Address
4943 SLAUSON AVE
MAYWOOD, CA 90270-3020
Grant Number
H80CS12858
Participating Start Date
7/1/2016
Last Recertification Date
2/2/2022
Entity Termination Date
4/1/2023
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2886
Pharmacy Address
8500 WASHINGTON BLVD.
PICO RIVERA, CA 90660
Pharmacy Comments
Contract Details
Approval Date
7/1/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Raquel R. Villa, Chief Executive Officer
(562) 776-5014
Contract Pharmacy Representative
Family Health Care Centers of Greater Los Angeles, INC.
Cindy C Wong, Pharmacist
(562) 776-5050
Signed By Date
7/1/2020
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