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Walmart Pharmacy 10-7611
FQHC638012G Northern Valley Indian Health
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Covered Entity Details
Entity Name
Northern Valley Indian Health
Subdivision Name
Concord Avenue Clinic
Type
Tribal Contract/Compact with IHS (P.L. 93-638)
340B ID
FQHC638012G
Entity Address
1990 Concord Ave
Chico, CA 95928
Grant Number
Participating Start Date
10/1/2022
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
10/9/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Inder Wadhwa, CEO
(530) 896-9409
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/9/2023
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