Contract Pharmacy Details

WAL-MART PHARMACY 10-2052
CH091940 MENDOCINO COMMUNITY HEALTH CLINIC, INC.

Covered Entity Details

Entity Name

MENDOCINO COMMUNITY HEALTH CLINIC, INC.

Subdivision Name

Hillside Health Center

Type

HRSA-Funded Health Center

340B ID

CH091940

Entity Address

333 Laws Ave
Ukiah, CA 95482-6540

Grant Number

H80CS00628

Participating Start Date

7/1/1995

Last Recertification Date

2/25/2025

Pharmacy Details

Pharmacy Name

WAL-MART PHARMACY 10-2052

Pharmacy Address

1155 AIRPORT PARK BLVD.
UKIAH, CA 95482

Pharmacy Comments

Contract Details

Approval Date

6/20/2012

Contract Begin Date

6/20/2012

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Linnea Hunter, CEO
(707) 468-1010

Contract Pharmacy Representative

Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374

Signed By Date

5/29/2012

340B Drug Pricing Program Database