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WAL-MART PHARMACY 10-1877
CH09364P FAMILY HEALTHCARE NETWORK
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Covered Entity Details
Entity Name
FAMILY HEALTHCARE NETWORK
Subdivision Name
Family HealthCare Network - Porterville Dental Center
Type
HRSA-Funded Health Center
340B ID
CH09364P
Entity Address
1133 W Poplar Ave
Porterville, CA 93257-5839
Grant Number
H80CS00786
Participating Start Date
7/1/2015
Last Recertification Date
3/4/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1877
Pharmacy Address
1250 WEST HENDERSON AVE
PORTERVILLE, CA 93257
Pharmacy Comments
Contract Details
Approval Date
7/13/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kerry Hydash, President and CEO
(559) 737-4700
Contract Pharmacy Representative
Walmart
Van Donn, 340B Director Contracting
(479) 273-4000
Signed By Date
7/13/2024
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