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Walmart Pharmacy 10-7611
CH061290 LA CASA DE BUENA SALUD
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Covered Entity Details
Entity Name
LA CASA DE BUENA SALUD
Subdivision Name
Type
HRSA-Funded Health Center
340B ID
CH061290
Entity Address
1515 WEST FIR
PORTALES, NM 88130
Grant Number
H80CS00404
Participating Start Date
12/1/1992
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
1/16/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Carmen Pacheco, COO
(575) 356-6695 Ext: 3801
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
1/16/2024
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