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WALMART PHARMACY 10-5828
CH08017C PUEBLO COMMUNITY HEALTH CENTER
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Covered Entity Details
Entity Name
PUEBLO COMMUNITY HEALTH CENTER
Subdivision Name
O'ROURKE DENTAL CLINIC
Type
HRSA-Funded Health Center
340B ID
CH08017C
Entity Address
2030 Lake Ave
Pueblo, CO 81004-3536
Grant Number
H80CS00692
Participating Start Date
10/1/2003
Last Recertification Date
3/2/2025
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-5828
Pharmacy Address
2730 S. PRAIRIE AVE
PUEBLO, CO 81005
Pharmacy Comments
Contract Details
Approval Date
4/12/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Donald Moore, CEO
(719) 543-8718 Ext: 139
Contract Pharmacy Representative
PCHC
Jenna Valentine, Pharmacy Director
(719) 543-8711
Signed By Date
4/12/2024
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