340B Drug Pricing Program Database

Pharmacy Name

WAL-MART PHARMACY 10-2052

Pharmacy Address

1155 AIRPORT PARK BLVD.
UKIAH, CA 95482

Pharmacy Comments

Approval Date

2/28/2013

Contract Begin Date

4/1/2013

Carve-In Effective Date

Contract Comments

Covered Entity Signing Official

Brandon Parker, CFO
(707) 467-5270

Contract Pharmacy Representative

Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374

Signed By Date

1/15/2013