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WAL-MART PHARMACY 10-3604
STD85012 Spectrum Medical Care Center
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Covered Entity Details
Entity Name
Spectrum Medical Care Center
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD85012
Entity Address
52 E Monterey Way
Suite A
Phoenix, AZ 85012
Grant Number
1 NU62PS924550-01-00
Participating Start Date
1/1/2019
Last Recertification Date
5/7/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-3604
Pharmacy Address
14200 WEST INDIAN SCHOOL RD.
GOODYEAR, AZ 85395
Pharmacy Comments
Contract Details
Approval Date
1/13/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Amy Sneor, Chief Executive Officer
(602) 604-9500
Contract Pharmacy Representative
Walmart
Nick Tallman, Sr. Director, Merchandise Operations – Pharmacy
(479) 371-0417
Signed By Date
1/13/2025
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