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WAL-MART PHARMACY 10-1058
CHC24176-05 OLATHE COMMUNITY CLINIC, INC.
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Covered Entity Details
Entity Name
OLATHE COMMUNITY CLINIC, INC.
Subdivision Name
River Valley Family Health Center of Delta
Type
HRSA-Funded Health Center
340B ID
CHC24176-05
Entity Address
1250 Valley View Dr
Delta, CO 81416-3138
Grant Number
H80CS24176
Participating Start Date
10/1/2023
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1058
Pharmacy Address
16750 S. TOWNSEND
MONTROSE, CO 81401
Pharmacy Comments
Contract Details
Approval Date
7/5/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kaye Hotsenpiller, CEO
(970) 250-5775
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
7/5/2024
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