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Walmart Pharmacy 10-7611
CHC22686-00 BARTZ-ALTADONNA COMMUNITY HEALTH CENTER
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Covered Entity Details
Entity Name
BARTZ-ALTADONNA COMMUNITY HEALTH CENTER
Subdivision Name
Bartz-Altadonna Community Health Center
Type
HRSA-Funded Health Center
340B ID
CHC22686-00
Entity Address
43322 Gingham Ave.
43322
Gingham Ave
Lancaster, CA 93535
Grant Number
H80CS22686
Participating Start Date
7/1/2012
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
10/11/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/31/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Mary Cummings, CEO
(661) 579-9317
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
10/11/2023
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