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WAL-MART PHARMACY 10-1697
FQHCLA247C HEALTH AND LIFE ORGANIZATION, INC. (H.A.L.O.)
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Covered Entity Details
Entity Name
HEALTH AND LIFE ORGANIZATION, INC. (H.A.L.O.)
Subdivision Name
Sacramento Community Clinic - Del Paso Dental
Type
Health Center Program Look-Alike
340B ID
FQHCLA247C
Entity Address
2138 Del Paso Blvd
Sacramento, CA 95815-3002
Grant Number
LALCS00018
Participating Start Date
1/1/2014
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1697
Pharmacy Address
8465 ELK GROVE BLVD
ELK GROVE, CA 95758
Pharmacy Comments
Contract Details
Approval Date
1/12/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
JERRY T. BLIATOUT, CEO
(916) 428-3788 Ext: 4236
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
1/12/2024
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