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WAL-MART PHARMACY 10-2494
CH09167N VISTA COMMUNITY CLINIC
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Covered Entity Details
Entity Name
VISTA COMMUNITY CLINIC
Subdivision Name
VCC Mobile Wellness Unit
Type
HRSA-Funded Health Center
340B ID
CH09167N
Entity Address
1000 Vale Terrace Dr
Vista, CA 92084-5218
Grant Number
H80CS00282
Participating Start Date
10/1/2022
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2494
Pharmacy Address
2100 VISTA WAY
OCEANSIDE, CA 92054
Pharmacy Comments
Contract Details
Approval Date
7/12/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/4/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Michele Lambert, CFO
(760) 216-5803
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
7/12/2023
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