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WAL-MART PHARMACY 10-1880
CH1010860 WATERFALL CLINIC INC
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Covered Entity Details
Entity Name
WATERFALL CLINIC INC
Subdivision Name
WATERFALL CLINIC, INC.
Type
HRSA-Funded Health Center
340B ID
CH1010860
Entity Address
1890 Waite St STE 1
North Bend, OR 97459-1229
Grant Number
H80CS08771
Participating Start Date
1/1/2008
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1880
Pharmacy Address
2051 NEWMARK AVENUE
COOS BAY, OR 97420
Pharmacy Comments
Contract Details
Approval Date
4/15/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Andrea Zamora, CFO
(808) 213-5055
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/15/2021
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