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WAL-MART PHARMACY 10-1608
FQHC638012 NORTHERN VALLEY INDIAN HEALTH
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Covered Entity Details
Entity Name
NORTHERN VALLEY INDIAN HEALTH
Subdivision Name
Type
Tribal Contract/Compact with IHS (P.L. 93-638)
340B ID
FQHC638012
Entity Address
207 N BUTTE STREET
WILLOWS, CA 95988
Grant Number
Participating Start Date
1/1/1995
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1608
Pharmacy Address
608 LUTHER
RED BLUFF, CA 96080
Pharmacy Comments
Contract Details
Approval Date
7/11/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Inder Wadhwa, CEO
(530) 896-9409
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
7/11/2024
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