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WAL-MART PHARMACY 10-1324
CH09009E Mariposa Community Health Center, Inc.
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Covered Entity Details
Entity Name
Mariposa Community Health Center, Inc.
Subdivision Name
Mariposa Nogales West
Type
HRSA-Funded Health Center
340B ID
CH09009E
Entity Address
1209 W Target Range Rd
Nogales, AZ 85621-2466
Grant Number
H80CS00752
Participating Start Date
12/22/2020
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1324
Pharmacy Address
100 WEST WHITE PARK DR
NOGALES, AZ 85621
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
Daniel Prevost, CEO
(520) 281-1550 Ext: 1005
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/10/2023
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