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WAL-MART PHARMACY 10-1231
CH08165AG CLINICA CAMPESINA/FAMILY HEALTH SERVICES
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Covered Entity Details
Entity Name
CLINICA CAMPESINA/FAMILY HEALTH SERVICES
Subdivision Name
Clinica Family Health & Wellness -- Dixon Clinic
Type
HRSA-Funded Health Center
340B ID
CH08165AG
Entity Address
1455 Dixon Ave
Lafayette, CO 80026-8879
Grant Number
H80CS00690
Participating Start Date
4/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1231
Pharmacy Address
9901 GRANT ST.
THORNTON, CO 80229
Pharmacy Comments
Contract Details
Approval Date
1/29/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Simon Smith, CEO
(303) 665-3036 Ext: 1003
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
1/14/2025
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