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WAL-MART PHARMACY 10-5658
CH09071BF 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 Santa Maria Women's Health B
Type
HRSA-Funded Health Center
340B ID
CH09071BF
Entity Address
116 S Palisade Dr STE 306
Santa Maria, CA 93454
Grant Number
H80CS00621
Participating Start Date
11/2/2022
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5658
Pharmacy Address
2240 S BRADLEY RD
SANTA MARIA, CA 93454
Pharmacy Comments
Contract Details
Approval Date
6/9/2023
Contract Begin Date
6/9/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
RONALD E. CASTLE, CEO
(805) 459-1835
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
6/9/2023
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