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WAL-MART PHARMACY 10-1616
CH091960 NORTHEASTERN RURAL HEALTH CLINICS, INC.
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Covered Entity Details
Entity Name
NORTHEASTERN RURAL HEALTH CLINICS, INC.
Subdivision Name
NORTHEASTERN HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH091960
Entity Address
1850 SPRING RIDGE DRIVE
SUSANVILLE, CA 96130
Grant Number
H80CS00709
Participating Start Date
4/1/1998
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1616
Pharmacy Address
2900 MAIN STREET
SUSANVILLE, CA 96130
Pharmacy Comments
Contract Details
Approval Date
10/19/2012
Contract Begin Date
10/19/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Pierce Leavall, Chief Executive Officer
(530) 251-5000
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
9/19/2012
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