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WAL-MART PHARMACY 10-3133
CHC10608-00 CENTRAL CITY COMMUNITY HEALTH CENTER, INC
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Covered Entity Details
Entity Name
CENTRAL CITY COMMUNITY HEALTH CENTER, INC
Subdivision Name
Central City Community Health Center, Inc. - Anaheim
Type
HRSA-Funded Health Center
340B ID
CHC10608-00
Entity Address
2237 W.Ball Road
Anaheim, CA 92804-5314
Grant Number
H80CS10608
Participating Start Date
7/1/2024
Last Recertification Date
2/27/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-3133
Pharmacy Address
1425 N HACIENDA BLVD
LA PUENTE, CA 91744
Pharmacy Comments
Contract Details
Approval Date
7/17/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Sommer R Kaskowitz, Chief Nursing Officer
(323) 724-0019 Ext: 1026
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
7/17/2017
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