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WAL-MART PHARMACY 10-5980
CH0921760 WESTERN SIERRA MEDICAL CLINIC
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Covered Entity Details
Entity Name
WESTERN SIERRA MEDICAL CLINIC
Subdivision Name
Type
HRSA-Funded Health Center
340B ID
CH0921760
Entity Address
209 NEVADA STREET
DOWNIEVILLE, CA 95936
Grant Number
H80CS08234
Participating Start Date
4/1/2007
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5980
Pharmacy Address
4080 DOUGLAS BLVD.
GRANITE BAY, CA 95746
Pharmacy Comments
Contract Details
Approval Date
1/8/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
Jennifer Malone, CEO
(530) 273-3819
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/8/2024
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