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WAL-MART PHARMACY 10-5997
CHC33795-04 Monterey, County Of
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Covered Entity Details
Entity Name
Monterey, County Of
Subdivision Name
County of Monterey Integrated Health Clinic
Type
HRSA-Funded Health Center
340B ID
CHC33795-04
Entity Address
299 12th St
Marina, CA 93933-6003
Grant Number
H80CS33795
Participating Start Date
1/1/2020
Last Recertification Date
3/4/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5997
Pharmacy Address
9600 PARKSOUTH CT. SUITE 100
ORLANDO, FL 32837
Pharmacy Comments
Contract Details
Approval Date
10/12/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Prashant Shinde, Bureau Chief
(831) 796-1370
Contract Pharmacy Representative
Walmart
Craig Smith, RPh.
(479) 903-5739
Signed By Date
10/12/2021
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