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WAL-MART PHARMACY 10-2053
FQHC638012C NORTHERN VALLEY INDIAN HEALTH
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Covered Entity Details
Entity Name
NORTHERN VALLEY INDIAN HEALTH
Subdivision Name
WOODLAND
Type
Tribal Contract/Compact with IHS (P.L. 93-638)
340B ID
FQHC638012C
Entity Address
175 W. Court Street
Woodland, CA 95695
Grant Number
Participating Start Date
10/1/2012
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2053
Pharmacy Address
470 N AIRPORT ROAD
WILLOWS, CA 95988
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, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
7/11/2024
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