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WAL-MART PHARMACY 10-5394
CH0919630 LIVINGSTON COMMUNITY HEALTH
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Covered Entity Details
Entity Name
LIVINGSTON COMMUNITY HEALTH
Subdivision Name
LIVINGSTON HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH0919630
Entity Address
1140 MAIN STREET
LIVINGSTON, CA 95334
Grant Number
H80CS02588
Participating Start Date
1/1/2005
Last Recertification Date
2/5/2020
Entity Termination Date
4/1/2021
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5394
Pharmacy Address
770 WEST EL MONTE WAY
DINUBA, CA 93618
Pharmacy Comments
Contract Details
Approval Date
10/14/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/24/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Leslie McGowan, CEO
(209) 394-7913 Ext: 1365
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
10/14/2016
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