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WALMART PHARMACY 10-5169
CHC02325-00 INDIAN HEALTH CENTER OF SANTA CLARA VALLEY
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Covered Entity Details
Entity Name
INDIAN HEALTH CENTER OF SANTA CLARA VALLEY
Subdivision Name
INDIAN HEALTH CENTER OF SANTA CLARA
Type
HRSA-Funded Health Center
340B ID
CHC02325-00
Entity Address
1333 Meridian Ave
San Jose, CA 95125-5212
Grant Number
H80CS02325
Participating Start Date
4/1/2013
Last Recertification Date
2/24/2025
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-5169
Pharmacy Address
2252 NORTH 8TH STREET
SUITE A
ROGERS, AR 72756
Pharmacy Comments
Contract Details
Approval Date
10/18/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Sonya Tetnowski, CEO
(408) 445-3400 Ext: 5000
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/18/2023
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