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WAL-MART PHARMACY 10-5979
CHC24113-00 Elica Health Centers
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Covered Entity Details
Entity Name
Elica Health Centers
Subdivision Name
Elica Health Centers
Type
HRSA-Funded Health Center
340B ID
CHC24113-00
Entity Address
155 15th St
West Sacramento, CA 95691
Grant Number
H80CS24113
Participating Start Date
1/1/2018
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5979
Pharmacy Address
255 LINCOLN BLVD.
LINCOLN, CA 95648
Pharmacy Comments
Contract Details
Approval Date
10/17/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/8/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
David E Hughes, COO/CFO
(916) 569-8484 Ext: 312
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/17/2022
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