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WAL-MART PHARMACY 10-1963
CH090470 GOLDEN VALLEY HEALTH CENTERS
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Covered Entity Details
Entity Name
GOLDEN VALLEY HEALTH CENTERS
Subdivision Name
GVHC - MERCED SUITES
Type
HRSA-Funded Health Center
340B ID
CH090470
Entity Address
847 W. CHILDS AVE
MERCED, CA 95341-6862
Grant Number
H80CS00742
Participating Start Date
12/1/1992
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1963
Pharmacy Address
2111 FULKERTH RD
TURLOCK, CA 95380
Pharmacy Comments
Contract Details
Approval Date
4/9/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tony Weber, CEO
(209) 385-5551
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
4/9/2015
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