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WALMART PHARMACY 10-4101
CHC00850-00 WATTS HEALTHCARE CORPORATION
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Covered Entity Details
Entity Name
WATTS HEALTHCARE CORPORATION
Subdivision Name
Type
HRSA-Funded Health Center
340B ID
CHC00850-00
Entity Address
10300 COMPTON AVENUE
LOS ANGELES, CA 90002
Grant Number
H80CS00850
Participating Start Date
1/1/2009
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-4101
Pharmacy Address
3705 E. SOUTH STREET
LONG BEACH, CA 90805
Pharmacy Comments
Contract Details
Approval Date
1/25/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/31/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Roderick Seamster, President & CEO
(323) 357-6688
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
1/25/2016
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