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WAL-MART CENTRAL FILL 10-2670
DSH050110 LOMPOC HEALTHCARE DISTRICT
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Covered Entity Details
Entity Name
LOMPOC HEALTHCARE DISTRICT
Subdivision Name
dba Lompoc Valley Medical Center
Type
Disproportionate Share Hospital
340B ID
DSH050110
Entity Address
1515 EAST OCEAN AVENUE
LOMPOC, CA 93436
Medicare Provider Number
050110
Participating Start Date
1/1/2007
Last Recertification Date
9/9/2024
Pharmacy Details
Pharmacy Name
WAL-MART CENTRAL FILL 10-2670
Pharmacy Address
608 SPRING HILL DR # 3 SUITE 300
SPRING, TX 77386
Pharmacy Comments
Contract Details
Approval Date
7/17/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/26/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
JAMES J. RAGGIO, Chief Executive Officer
(805) 737-3301
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
7/17/2017
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