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WAL-MART PHARMACY 10-5659
CH09071L COMMUNITY HEALTH CENTERS OF THE CENTRAL COAST, INC.
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Covered Entity Details
Entity Name
COMMUNITY HEALTH CENTERS OF THE CENTRAL COAST, INC.
Subdivision Name
COMMUNITY HEALTH CENTERS GUADALUPE
Type
HRSA-Funded Health Center
340B ID
CH09071L
Entity Address
4723 W MAIN ST, STE H.
GUADALUPE, CA 93434
Grant Number
H80CS00621
Participating Start Date
1/1/2004
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5659
Pharmacy Address
500 SOUTH BLOSSER RD
SANTA MARIA, CA 93454
Pharmacy Comments
Contract Details
Approval Date
5/5/2023
Contract Begin Date
5/8/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
RONALD E. CASTLE, CEO
(805) 459-1835
Contract Pharmacy Representative
Walmart
Christian Nava, Senior Manager, Program Development-340B
(210) 632-0647
Signed By Date
5/5/2023
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