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WALMART PHARMACY 10-5968
CH036820 LA CLINICA DEL PUEBLO
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Covered Entity Details
Entity Name
LA CLINICA DEL PUEBLO
Subdivision Name
Type
HRSA-Funded Health Center
340B ID
CH036820
Entity Address
2831 15TH STREET NW
WASHINGTON, DC 20009
Grant Number
H80CS08244
Participating Start Date
1/1/2008
Last Recertification Date
2/20/2025
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-5968
Pharmacy Address
5929 GEORGIA AVE NW
WASHINGTON, DC 20011
Pharmacy Comments
Contract Details
Approval Date
7/10/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/15/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Catalina Sol, Executive Director
(202) 448-2810
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
7/10/2023
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