Contract Pharmacy Details

WAL-MART PHARMACY 10-2507
CH09071C COMMUNITY HEALTH CENTERS OF THE CENTRAL COAST, INC.

Covered Entity Details

Entity Name

COMMUNITY HEALTH CENTERS OF THE CENTRAL COAST, INC.

Subdivision Name

DOCTORS OFFICE/FAIR OAKS COMMUNITY HEALTH CENTERS

Type

HRSA-Funded Health Center

340B ID

CH09071C

Entity Address

1057 E GRAND AVE
ARROYO GRANDE, CA 93420-2504

Grant Number

H80CS00621

Participating Start Date

4/1/1997

Last Recertification Date

2/11/2025

Pharmacy Details

Pharmacy Name

WAL-MART PHARMACY 10-2507

Pharmacy Address

2220 SOUTH BRADLEY
SANTA MARIA, CA 93455

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

340B Drug Pricing Program Database