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WAL-MART PHARMACY 10-2292
FQHCLA397B Health Service Alliance
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Covered Entity Details
Entity Name
Health Service Alliance
Subdivision Name
Health Service Alliance
Type
Health Center Program Look-Alike
340B ID
FQHCLA397B
Entity Address
9804 Foothill Blvd
Rancho Cucamonga, CA 91730-3616
Grant Number
LALCS33333
Participating Start Date
10/1/2021
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2292
Pharmacy Address
1275 NORTH AZUSA AVENUE
COVINA, CA 91722
Pharmacy Comments
Contract Details
Approval Date
4/15/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jeff Cox, Chief Executive Officer
(909) 784-6117
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/15/2025
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