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WAL-MART PHARMACY 10-5997
CH094890 VENICE FAMILY CLINIC
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Covered Entity Details
Entity Name
VENICE FAMILY CLINIC
Subdivision Name
VENICE FAMILY CLINIC
Type
HRSA-Funded Health Center
340B ID
CH094890
Entity Address
604 Rose Ave
Venice, CA 90291-2767
Grant Number
H80CS04217
Participating Start Date
10/1/1997
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5997
Pharmacy Address
9600 PARKSOUTH CT. SUITE 100
ORLANDO, FL 32837
Pharmacy Comments
Contract Details
Approval Date
10/13/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/13/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Mitesh G Popat, CEO
(310) 664-7901
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/13/2023
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