Contract Pharmacy Details

WAL-MART PHARMACY #10-1651
CH092420 OLE HEALTH

Covered Entity Details

Entity Name

OLE HEALTH

Subdivision Name

OLE Health - North Napa Campus

Type

HRSA-Funded Health Center

340B ID

CH092420

Entity Address

1141 PEAR TREE LANE
Suite 100
NAPA, CA 94558-6485

Grant Number

H80CS04219

Participating Start Date

10/1/2004

Last Recertification Date

2/21/2025

Pharmacy Details

Pharmacy Name

WAL-MART PHARMACY #10-1651

Pharmacy Address

7011 NORTH MAIN STREET
AMERICAN CANYON, CA 94503

Pharmacy Comments

Contract Details

Approval Date

4/1/2014

Contract Begin Date

7/1/2014

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Tanir Ami, Chief Executive Officer
(707) 254-1770 Ext: 214

Contract Pharmacy Representative

Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374

Signed By Date

4/1/2014

340B Drug Pricing Program Database