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WAL-MART PHARMACY 10-4430
CH090030 SUN LIFE FAMILY HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
SUN LIFE FAMILY HEALTH CENTER, INC.
Subdivision Name
Sun Life Health - Casa Grande Family Practice, Dental & Orthodontics
Type
HRSA-Funded Health Center
340B ID
CH090030
Entity Address
865 N Arizola Rd
Casa Grande, AZ 85122-6011
Grant Number
H80CS00466
Participating Start Date
12/1/1992
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-4430
Pharmacy Address
41650 W MARICOPA CASA GRANDE
MARICOPA, AZ 85138
Pharmacy Comments
Contract Details
Approval Date
3/5/2012
Contract Begin Date
3/5/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
TRAVIS ROBINETTE, CEO
(520) 836-3446 Ext: 2303
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
2/23/2012
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