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WALMART PHARMACY 10-5169
CH100150 Siskiyou Community Health Center, Inc.
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Covered Entity Details
Entity Name
Siskiyou Community Health Center, Inc.
Subdivision Name
SISKIYOU COMMUNITY HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH100150
Entity Address
1701 NW Hawthorne Avenue
Grants Pass, OR 97526-1257
Grant Number
H80CS00369
Participating Start Date
7/1/2007
Last Recertification Date
2/13/2025
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
7/2/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Dawn Weber, Chief Executive Officer
(541) 472-4777 Ext: 1155
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
7/2/2024
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