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WALMART PHARMACY 10-5169
CHC12858-06 FAMILY HEALTH CARE CENTERS OF GREATER LOS ANGELES INC
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Covered Entity Details
Entity Name
FAMILY HEALTH CARE CENTERS OF GREATER LOS ANGELES INC
Subdivision Name
Fedde School Based Health Center
Type
HRSA-Funded Health Center
340B ID
CHC12858-06
Entity Address
21409 Elaine Ave
Hawaiian Gardens, CA 90716-1025
Grant Number
H80CS12858
Participating Start Date
4/1/2024
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-5169
Pharmacy Address
2252 NORTH 8TH STREET
SUITE A
ROGERS, AR 72756
Pharmacy Comments
Contract Details
Approval Date
4/9/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Raquel R. Villa, Chief Executive Officer
(562) 776-5014
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/9/2024
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