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WAL-MART PHARMACY 10-2044
FQHC638012E Northern Valley Indian Health
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Covered Entity Details
Entity Name
Northern Valley Indian Health
Subdivision Name
Type
Tribal Contract/Compact with IHS (P.L. 93-638)
340B ID
FQHC638012E
Entity Address
500 Cohasset Rd.
15
Chico, CA 95926
Grant Number
Participating Start Date
7/1/2016
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2044
Pharmacy Address
2044 FOREST AVENUE
CHICO, CA 95928
Pharmacy Comments
Contract Details
Approval Date
7/17/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Inder Wadhwa, CEO
(530) 896-9409
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
7/17/2023
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