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WAL-MART PHARMACY 10-2007
CH10100B MOSES LAKE COMMUNITY HEALTH CENTER
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Covered Entity Details
Entity Name
MOSES LAKE COMMUNITY HEALTH CENTER
Subdivision Name
Ephrata Community Dental Clinic
Type
HRSA-Funded Health Center
340B ID
CH10100B
Entity Address
457 1st Avenue NW
EPHRATA, WA 98823
Grant Number
H80CS00702
Participating Start Date
1/1/2016
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2007
Pharmacy Address
1005 NORTH STRATFORD ROAD
MOSES LAKE, WA 98837
Pharmacy Comments
Contract Details
Approval Date
1/14/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Sheila Berschauer, CEO
(509) 765-0674 Ext: 2411
Contract Pharmacy Representative
Moses Lake Community Health Center
Bothaina Mousa, Director of Pharmacy
(509) 765-0675 Ext: 3232
Signed By Date
1/14/2024
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