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WAL-MART PHARMACY 10-4336
CH093030 ADELANTE HEALTHCARE, INC.
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Covered Entity Details
Entity Name
ADELANTE HEALTHCARE, INC.
Subdivision Name
Adelante Healthcare
Type
HRSA-Funded Health Center
340B ID
CH093030
Entity Address
3033 N. Central Ave.
Phoenix, AZ 85012-4403
Grant Number
H80CS00140
Participating Start Date
12/1/1992
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-4336
Pharmacy Address
12900 WEST THUNDERBIRD
EL MIRAGE, AZ 85335
Pharmacy Comments
Contract Details
Approval Date
4/7/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/15/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Richard Miller, CFO
(623) 583-3001
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
4/7/2015
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