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WALMART PHARMACY 10-4393
CHC24113-15 ELICA HEALTH CENTERS
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Covered Entity Details
Entity Name
ELICA HEALTH CENTERS
Subdivision Name
Elica Health Centers - Marysville
Type
HRSA-Funded Health Center
340B ID
CHC24113-15
Entity Address
3234 Marysville Blvd
Sacramento, CA 95815
Grant Number
H80CS24113
Participating Start Date
1/1/2020
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-4393
Pharmacy Address
4675 WATT AVENUE
NORTH HIGHLANDS, CA 95660
Pharmacy Comments
Contract Details
Approval Date
10/16/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
David E Hughes, COO/CFO
(916) 569-8484 Ext: 312
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/16/2023
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