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WAL-MART PHARMACY 10-2556
CH09071AQ 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 BROADWAY DENTAL
Type
HRSA-Funded Health Center
340B ID
CH09071AQ
Entity Address
210 N Broadway
Santa Maria, CA 93454-4415
Grant Number
H80CS00621
Participating Start Date
1/1/2016
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2556
Pharmacy Address
1168 WEST BRANCH STREET
ARROYO GRANDE, CA 93420
Pharmacy Comments
Contract Details
Approval Date
6/9/2023
Contract Begin Date
6/9/2023
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
6/9/2023
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