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WAL-MART PHARMACY 10-5629
CH091540 OPEN DOOR COMMUNITY HEALTH CENTERS
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Covered Entity Details
Entity Name
OPEN DOOR COMMUNITY HEALTH CENTERS
Subdivision Name
Arcata Community Health Center
Type
HRSA-Funded Health Center
340B ID
CH091540
Entity Address
1150 Foster Avenue
Arcata, CA 95521-6210
Grant Number
H80CS00225
Participating Start Date
7/1/1996
Last Recertification Date
2/24/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5629
Pharmacy Address
3300 BROADWAY BASHORE MALL
EUREKA, CA 95501
Pharmacy Comments
Contract Details
Approval Date
7/5/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Herrmann Spetzler, CEO
(707) 826-8633 Ext: 5124
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
7/5/2017
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