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WAL-MART PHARMACY 10-5839
CH10079AD La Clinica Del Valle Family Health Care Center, Inc.
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Covered Entity Details
Entity Name
La Clinica Del Valle Family Health Care Center, Inc.
Subdivision Name
La Clinica Acute Care Clinic
Type
HRSA-Funded Health Center
340B ID
CH10079AD
Entity Address
616 Market St
Medford, OR 97504-6126
Grant Number
H80CS00759
Participating Start Date
7/1/2021
Last Recertification Date
1/30/2024
Entity Termination Date
1/1/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5839
Pharmacy Address
3615 CRATER LAKE HWY
MEDFORD, OR 97504
Pharmacy Comments
Contract Details
Approval Date
1/11/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Traci Fossen, Chief Quality Officer
(541) 512-3912
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/11/2024
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