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WAL-MART PHARMACY 10-2780
CH101630 VALLEY FAMILY HEALTH CARE INC
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Covered Entity Details
Entity Name
VALLEY FAMILY HEALTH CARE INC
Subdivision Name
VALLEY FAMILY HEALTH CARE - Payette Medical Clinic
Type
HRSA-Funded Health Center
340B ID
CH101630
Entity Address
1441 NE 10th Ave
Payette, ID 83661-5420
Grant Number
H80CS00556
Participating Start Date
12/1/1992
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2780
Pharmacy Address
5108 EAST CLEVELAND BLVD
CALDWELL, ID 83607
Pharmacy Comments
Contract Details
Approval Date
1/15/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Timothy Heinze, CEO
(208) 642-7364
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
1/15/2022
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