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WALMART PHARMACY 10-5169
CH0910370 ST. JOHN'S WELL CHILD AND FAMILY CENTER, INC.
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Covered Entity Details
Entity Name
ST. JOHN'S WELL CHILD AND FAMILY CENTER, INC.
Subdivision Name
St. Johns Well Child and Family Center Magnolia Place
Type
HRSA-Funded Health Center
340B ID
CH0910370
Entity Address
1910 Magnolia Ave
101
Los Angeles, CA 90007
Grant Number
H80CS00873
Participating Start Date
7/1/2003
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
Contacts
Covered Entity Signing Official
James Mangia, CEO
(323) 541-1600 Ext: 4000
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/13/2023
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