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WALMART PHARMACY 10-5637
CH09167L VISTA COMMUNITY CLINIC
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Covered Entity Details
Entity Name
VISTA COMMUNITY CLINIC
Subdivision Name
VCC: Mission Dental
Type
HRSA-Funded Health Center
340B ID
CH09167L
Entity Address
1910 Mission Ave
Oceanside, CA 92058-7129
Grant Number
H80CS00282
Participating Start Date
10/1/2020
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-5637
Pharmacy Address
1046 MISSION AVE
OCEANSIDE, CA 92054
Pharmacy Comments
Contract Details
Approval Date
1/12/2023
Contract Begin Date
1/12/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michele Lambert, CFO
(760) 216-5803
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
1/12/2023
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