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Walmart Pharmacy 10-7611
CH091960 NORTHEASTERN RURAL HEALTH CLINICS, INC.
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Covered Entity Details
Entity Name
NORTHEASTERN RURAL HEALTH CLINICS, INC.
Subdivision Name
NORTHEASTERN HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH091960
Entity Address
1850 SPRING RIDGE DRIVE
SUSANVILLE, CA 96130
Grant Number
H80CS00709
Participating Start Date
4/1/1998
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
10/10/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lacey Lively, Chief Financial Officer
(530) 251-1432
Contract Pharmacy Representative
PharmaForce
Janet Salmon, Senior Relationship Manager, Western Region
(484) 861-3986
Signed By Date
10/10/2023
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