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WALMART PHARMACY 10-5169
CH091960 NORTHEASTERN RURAL HEALTH CLINICS, INC.
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Covered Entity Details
Entity Name
NORTHEASTERN RURAL HEALTH CLINICS, INC.
Subdivision Name
NORTHEASTERN HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH091960
Entity Address
1850 SPRING RIDGE DRIVE
SUSANVILLE, CA 96130
Grant Number
H80CS00709
Participating Start Date
4/1/1998
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-5169
Pharmacy Address
2252 NORTH 8TH STREET
SUITE A
ROGERS, AR 72756
Pharmacy Comments
Contract Details
Approval Date
4/13/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Lacey Lively, Chief Financial Officer
(530) 251-1432
Contract Pharmacy Representative
PharmaForce
Janet Salmon, Senior Relationship Manager, Western Region
(484) 861-3986
Signed By Date
4/13/2023
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