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WALMART PHARMACY 10-2468
CH097880 PETALUMA HEALTH CENTER, INC
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Covered Entity Details
Entity Name
PETALUMA HEALTH CENTER, INC
Subdivision Name
Petaluma Health Center
Type
HRSA-Funded Health Center
340B ID
CH097880
Entity Address
1179 N. McDowell Blvd.
Petaluma, CA 94954-6559
Grant Number
H80CS00587
Participating Start Date
7/1/2000
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-2468
Pharmacy Address
901 GOLF COURSE DRIVE
ROHNERT PARK, CA 94928
Pharmacy Comments
Contract Details
Approval Date
10/14/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brian Burns, CFO
(707) 559-7588
Contract Pharmacy Representative
Wal-Mart
Marcus Osbourne, VP of Health and Wellness Transformation
(479) 204-9374
Signed By Date
10/14/2016
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