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WAL-MART PHARMACY 10-5129
CH03682A LA CLINICA DEL PUEBLO, INC.
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Covered Entity Details
Entity Name
LA CLINICA DEL PUEBLO, INC.
Subdivision Name
La Clinica del Pueblo - Hyattsville Site
Type
HRSA-Funded Health Center
340B ID
CH03682A
Entity Address
2970 Belcrest Center Drive, Suite #301
Hyattsville, MD 20782-2078
Grant Number
H80CS08244
Participating Start Date
4/1/2017
Last Recertification Date
2/20/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5129
Pharmacy Address
6210 ANNAPOLIS RD
LANDOVER HILLS, MD 20784
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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