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WAL-MART PHARMACY 10-3133
CHC10608-00 CENTRAL CITY COMMUNITY HEALTH CENTER, INC
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Covered Entity Details
Entity Name
CENTRAL CITY COMMUNITY HEALTH CENTER, INC
Subdivision Name
Central City Community Health Center, Inc. - Anaheim
Type
HRSA-Funded Health Center
340B ID
CHC10608-00
Entity Address
2237 W.Ball Road
Anaheim, CA 92804-5314
Grant Number
H80CS10608
Participating Start Date
7/1/2024
Last Recertification Date
2/27/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-3133
Pharmacy Address
1425 N HACIENDA BLVD
LA PUENTE, CA 91744
Pharmacy Comments
Contract Details
Approval Date
6/14/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Rosemary D. Reyes, CEO
(323) 724-0019 Ext: 1017
Contract Pharmacy Representative
Walmart
Van Donn, Director of Contracting 340b
(303) 261-5549
Signed By Date
5/10/2024
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