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WAL-MART PHARMACY 10-3525
CH10102BU Sea Mar Community Health Centers
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Covered Entity Details
Entity Name
Sea Mar Community Health Centers
Subdivision Name
Sea Mar CHC - Puyallup 101st Avenue Ct. E.
Type
HRSA-Funded Health Center
340B ID
CH10102BU
Entity Address
12812 101st Avenue Ct E
Puyallup, WA 98373
Grant Number
H80CS00445
Participating Start Date
7/1/2013
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-3525
Pharmacy Address
16502 MERIDAN AVE EAST
PUYALLUP, WA 98375
Pharmacy Comments
Contract Details
Approval Date
10/11/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mary Bartolo, Executive Vice President
(206) 763-5277
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
10/11/2023
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