Contract Pharmacy Details

WALMART PHARMACY 10-5169
CH090090 MARIPOSA COMMUNITY HEALTH CENTER, INC.

Covered Entity Details

Entity Name

MARIPOSA COMMUNITY HEALTH CENTER, INC.

Subdivision Name

MARIPOSA COMMUNITY HEALTH CENTER

Type

HRSA-Funded Health Center

340B ID

CH090090

Entity Address

1852 N Mastick Way
Nogales, AZ 85621-1063

Grant Number

H80CS00752

Participating Start Date

12/1/1992

Last Recertification Date

2/11/2025

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

4/17/2023

Contract Begin Date

7/1/2023

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Daniel Prevost, CEO
(520) 281-1550 Ext: 1005

Contract Pharmacy Representative

Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498

Signed By Date

4/17/2023

340B Drug Pricing Program Database