Contract Pharmacy Details

WAL-MART PHARMACY 10-2292
FQHCLA397E Health Service Alliance

Covered Entity Details

Entity Name

Health Service Alliance

Subdivision Name

Palm Desert Community Health Center

Type

Health Center Program Look-Alike

340B ID

FQHCLA397E

Entity Address

41990 Cook St STE F-2002
Palm Desert, CA 92211-6100

Grant Number

LALCS33333

Participating Start Date

10/1/2023

Last Recertification Date

3/6/2025

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

Christen Grelling, Chief Operations Officer
(909) 464-9675 Ext: 104

Contract Pharmacy Representative

Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498

Signed By Date

4/15/2025

340B Drug Pricing Program Database