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WAL-MART PHARMACY 10-5997
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 10-5997
Pharmacy Address
9600 PARKSOUTH CT. SUITE 100
ORLANDO, FL 32837
Pharmacy Comments
Contract Details
Approval Date
7/14/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tony Weber, CEO
(209) 385-5551
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
7/14/2017
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