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WALMART PHARMACY 10-3180
CHC12858-05 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
FHCCGLA Commerce
Type
HRSA-Funded Health Center
340B ID
CHC12858-05
Entity Address
6001 E Washington Blvd
Commerce, CA 90040-2451
Grant Number
H80CS12858
Participating Start Date
4/1/2022
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-3180
Pharmacy Address
4651 FIRESTONE BLVD
SOUTH GATE, CA 90280
Pharmacy Comments
Contract Details
Approval Date
2/1/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
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
1/14/2022
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