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WAL-MART PHARMACY 10-1218
CH09265B AJO COMMUNITY HEALTH CENTER
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Covered Entity Details
Entity Name
AJO COMMUNITY HEALTH CENTER
Subdivision Name
Desert Senita Dental Center
Type
HRSA-Funded Health Center
340B ID
CH09265B
Entity Address
410 N Malacate St BLDG B
Ajo, AZ 85321
Grant Number
H80CS00753
Participating Start Date
7/1/2024
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1218
Pharmacy Address
1741 EAST FLORENCE BLVD
CASA GRANDE, AZ 85122
Pharmacy Comments
Contract Details
Approval Date
4/15/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/10/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Daniel L Barbara, Chief Executive Officer
(520) 387-5651 Ext: 3007
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/15/2024
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