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WAL-MART PHARMACY 10-1951
CH10163J Valley Family Health Care, Inc.
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Covered Entity Details
Entity Name
Valley Family Health Care, Inc.
Subdivision Name
Valley Family Health Care - Payette Dental Clinic
Type
HRSA-Funded Health Center
340B ID
CH10163J
Entity Address
1501 NE 10th Ave
Payette, ID 83661-5420
Grant Number
H80CS00556
Participating Start Date
7/1/2017
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1951
Pharmacy Address
1775 E IDAHO AVENUE
ONTARIO, OR 97914
Pharmacy Comments
Contract Details
Approval Date
10/13/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ben Murray, COO
(208) 642-7364
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
10/13/2023
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